HomeMy WebLinkAbout0313 D~clara~ion og Dor~nicil~ and ~itii~~ns~ii~
4'76940
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E ppUN'ly, FLORIDA:
Ibis is mJ? decLration of Domic~s and Citixeaship in the State of Florida that I am Sling this daT in accordance. and in
conformity with .Section 222.17. Florida Statutes. .
I was formerly s legal resident of - !;1 l,Ll /Q EIV ~ t~ ~A,u~J~ase~ and I
11 l4`it71 ~ i9~atal
resided at S ~ ~7TL°@ ~ However. I have changed a~ domid7e to
t8treat and Nombar) -
and am end have been a bona Sde resident of the State of Ilorida since ~7 ~
Q~~of~ r , ls_! •
r
_ and I reside at 33 3 ~ t ,~j~4-y yi Ettil !err.
(8trwR aadNomb~r)
2T ~S ~ • !ri- u Li ~ ST . LUG 1 E CountT. Florida.
and this stateme~ is to be taken as m7 declaration of ctizeaship. actual legal residence and domic~7e in the State of Florida.
• .
If FOR THE PURPOSE OF ENROLLING IF FOR HONESTEAO PURPOSES,
CH I t.DREN I N SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
4'76940
t9°A Fr6 22 PN ~ 21
fILEO AhQrrCUdL'[U
SLLUCIE COUNTY.fLA.
ROGER POlTRAS
CLER1~clRCtllt. COURT
- RCCv*R L'EPiF1FD__ m
I F[JRTHER CERTIFY that I wiII register at m7 local address when the registration books reopen, sad comp), wkh all
other r~equir+emeats d a legal reaide~ at this State.
I FURTHER CERTII'Y that I have ao iatcntion to return to m~ former domicile. sad I intend to remain in
c.` - - - 3T . L U C 1 E Cou~j.
lvit7) . - -
Florida. permanentl,,•.
~ Y
sut3U
tom, t - i
lj,~~ .,y~~:. ~,,,.i! (Name
c'~ ~,~qN • draw)
sworn to sad subscribed befors me this °1 da, o[ _ ~ • ~yyc % E 33 ~ .f2_ .
~ ~1 . A.D.1 ~ G~~ ss ~i/ A- P~r~-~
ROGER POI TRAS. CLERK Of
G IRCUI T COtdRT
ST. L UG i E COUNTY, f LOR t OA
BY:
EPUTY tERK
• - B~K 326 •PAGE Jl~