HomeMy WebLinkAbout0512 ~ ~ -
. ~
)L
• a . • I'~ /
Dectarat~on of Domicile and Citizenship 1
4bi0'!80
TO THE CLERK OF THE CIIiCUIT COURT.
ST. LUG 1 E QOU~y~ FLORIDA:
This is mT declaration d DomicDs sad Clti:enship is the State d Fbrida that I am Sljng this d~ in aooosdanos. and is
oonformit~ with Section 222.17. Florida Statutes.
I was !o~ a legal raside»L of 1'Q i.~.o ~•,-?--~.L • and I -
lCtUl 18taW #
resided at o ~ > > ~ ~ - However. I haw changed m,T domiei7e to
18trmt sad N®DrH -
•
and am and have been a bona fide resident of the State d Fbrida since - 4 daT d
~ n ~ .151',-. and beside at a r J-F'1K .
lBtrMt ssia NaobR)
p, c ~ ST. LUG 1 E CoentT. Florida.
1c~sl
and this statement is to. be taten as ~ dee]aration of dtissnship. aetnal legal residence sad domidle in the State d Florida.
• ~IF FOR THE PURPOSE Of ENROIIING IF POR HOMESTEAQ PURPOSES,
CH 1 IOREN 1 N SCHOOt., PLEASE STATE PLEA~E~ CHECKS
THE 1R NAMES:
.flG~ LL~~ rJ~..u_~..s, ~ ~ a t,i J.
r--
. X80 MAR 2S pfd 4g
- ST E~C_OipE_I Y. A,
q.ERK ClftCt~I1TP01
1011'
- t~C~ VERIFIED
4bi0`780
I FZJRTZIER CERT'Il:'Y that I w>71 register at mT local address when the registration boob reopen. sad oompy with all
other regniremeats of a legal reaideat at this State.
I FURTAER CERT1FSf I haw no intention to return to former domie~7e. sad I intend to remain in
(csti)
Florida. permauend; .
- 1
. Gfl:~:?T - .
r~
- •
' ~
~ li. z .
f
, ;
' : ~ IN~awl
J
Sw~eii `t'o before aye this daT d /,rc,~~ D f~a_
ROGER POITRAS. CLERK OF CIRCUIT COC~tT N
- sQ~~Y ~ ~ ~~N~-
ST. l !E COUNTY, FLORtOA '
. 1
9YS a • ~
EPUTY tERK
i
AGO Form 71.22 ~
a - - _ -