HomeMy WebLinkAbout1256 - .r-
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- ~ f Dorr~icite and Cit~~ens~~p -
- Deciarat~or~ o -
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TO THE CLERK OF THE CIRCUIT BURT. .
~ l.UG 1 E QQUNZ'Y. FLORIDA: - .
than I am ~8 this d~ ~ aooordan~e. and m
This ~ ~r decLration of Dbmi~e and ~AS~ in the State of Florid: -
oanfotmity with Seetioa 222.17. Florida Statutes. ~l..~Rt~ andY -
- - I was f
~ a ~ resident of l~~ ~ ~
~ ~ V SST A W Howepsr. I have ehanSed m= da~°
resided at ~ • W
tSts..c,.aNa~1 --i o P~ ~ daTot
and am and have been s bona Sde:esident of the State of Fbrida autioe - -
.19 - and I scside at - lets gad risDed
w`~ ~ ST. LUG 1 E Coant~.t"lorida.
Q v T caal _
of dtiumt~. ~ X10° and domicile in the State ai Florida.
sad this statement is to be fates as p4T
I F -FOR HONESTEl10 PURPOSES,
IF FOR THE PURPOSE- Of ENROt.1.ING PLEASE CHECKS
CHILDREN IN SCHO01.~ P4EASE STATE -
THE IR NAMES: ~ Z~ ~ 00
Q~A(~a E7c.~~ Ig~
r- " _ 0 -
RQG~ ~
- 12~
pYEAlftEl? -
_ - - 4'7812
- - - and oomph wit)t aII
I F'tTR'1'AER CEA~ that I w~11 ~ mT local addi~ss when the registration nooks reopen. -
..menta d a legal rr~ide-'~t at thi+ State. -
otber reg ; -
I Ft7F.'THER CER'I'D'Y thst I 'have tw natxation to return tom former domicile. and -I t"O Conat7,
- (~1 - -
Fbrida, permanensl; • ~ .
i ,
. • 4 - _
\~'couNTy , ;
• u~ - 33 -
Sv?ora to sad anbxnted b.
fore me this , - - _
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A.D. i~.~.-- _
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- R pp AS C ERK OF GIRGUt T COfidRT -
ST. lUG1E EOUNTY, ftOR1OA .
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8Y. .av-~~
EPUTY LERK ~ i
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AGO Fnrm 7l