HomeMy WebLinkAbout0179 Declaration of Domicile and Citizenship
4323'76
TO THE CLERK OF THE CDZCUIT COURT. .
ST. lUG i E Cptn,~y, ~,O~A;
This is mT declaration of Domicile and Citiratuhip in the State of Florida that I am Sling this dq in aoeotdanoe. and in
oonfo~rmit~ with Section 222.17, Florida Statutes.
I was forme 1 a legal resident of ~0 ~'T CL i ,v~i-d .y ~ I~ /CJ ~ I
((~t~1 t8tatal
resided at "9G F_ TP RRA c c R c ~p However. I love ebanged ~ domits7e to
(8tsst..d Nu~b~r) _
. and am and have been a bona Sde resident of tbeState Q[Florida since - JAaJ daT o[
19_~SL, and I reside at /y / ue2 ~i/..L C~cG~.v II~LV ~
ttw~..t..arr~
JP•vs~.~. /3~,0~1 ST. LUG I E C~nnh. Florids.
tc~l
and this statement is to be taken as my declaration at dtisenship. actual legal residence and domict7e in the State of Florida.
If FOR THE PURPOSE OF ENROLLING _ IF FOR HOMESTEAD PURPOSES
CHILDREN tN SCHOOLs~ PLEASE STATE PLEASE CHECK:
~ THEIR NANES:
X80 APR -9 AN 9~ 4 2
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Wi~RASA.
~fRK allCt~ptT~t
~~.COU~i~
Rtl~ ~R1F1t:D~
Y~a7 t V
I FURTHER CERTIFY that I wt71 register at mT local address when the registration boob reopen. and oomplT with all
other requireme~s d a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return tom former domicile. and I intend to remain in
UC I E ~ ~T,
ItN~I -
Florida. permanend; .
,
''f.
(IVY
'Mora to std subscribed before me this ~ daT at J S ~ ti n~~~ ~ `/J~
•
A..D.1$~,~~
R A C ERK OF C 1 RCU I T COt~lt T
ST. IUGI~ COUNTY, FtORtOA
.
BYs
EPUTY IERK '