HomeMy WebLinkAbout0567 •
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' omicite and Citizenshi
Dectarat~on of D p
49'7106
To~c~oF~c~ooulrr.
ST. LUG f E_ OOTJNZ'Y. FLORIDA:
his is t~ deda>fstioa d Dom~o7s tad is the State d Florida tbst I am this daf is aoowdsnoa. tad in
co~R7 with Sedios? ~,aT. Fjocida t;ta~ea. •
and I
I was foanord s leant resident d tit t~
resided ai However. I bare changed m~ domic~7e to
t8ewe.r Zt..v.r1
and am tad have bees a boat fide resident d the State d i~'joeida siaoe of
~ ~8v _ ~ f amdt seaideet a~SO S~ ~Ol'D -
tttas•~N~
. ~Q /e r cf Ll~ / ~ ~ ST . L UG I E Coeat~. Floeda.
and this atatemeat is to be tatea :s mf deelata>tiioa d ~baip. setoal kaal :esidenes and domia7e in the State d Florida.
IF fOR THE PURPOSE Of EMROl~tN6 If fOR HOMESTEAD PURPOSES,
CHI~OREN IN SCHOOLa Pt,~ASt: STATE PLEASE CHECK:
THEIR MANES:
_ a R ~ 1~0 AU6 22 PM ~ OS
~r
ftLEO A1~~PECOROEO
ST~~U~R POITRAS A~
CLERK CtRCU1T COURT
- RECtMO vERtFtED_ _
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- = 49'7106
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I F CI~tT)FY that I wiH s~ et 4 local addicts when the registration books reopen. and aomPl7 with aU r
r atber regdaemesda d a kaal resadest d tlds State. i
I ~R tit I hae ao i~teatioe to retaan to farmer domia7e. and I intend to remain in
,r, u c t E Count7.
s y (Q~T) v ~ i~
Florida. permas
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.r ` ~ O ~ J ~J
Y X44
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. . ~ • ' a>,e this ~ daf d O ~ ~ ~ 1 •
_ t+o;~a~~ _ ,
•~e•FDi~ S. CLERK OF G IRGU17 ~OL~tT -
ST. LUG I E COUNTY, ftOR tOA
• _ E PUTY EER R
Bt10 JJ ( PkGE
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