HomeMy WebLinkAbout1068 Declaration of Domicile and Citizenship
TO THE cLERx oFTHE clRCVhroouRT. ~~424
ST. LUG 1 E OOUN'1'Y. FLORIDA:
This i, nqr dedaration of Domieila and Citiaenship in tbs State at Florida that I em SNoa thb dq is aoeoedanos. and in
coaformitT. with Section 222.17. Florida Statutes.
t
I was fr a legal resident at J~ ?`Q-- _ Ff ~ and I
l(2tj1 Itstatas
resided at 3 ~}'h n . n a S ~ ~ p ~ k~ - However. I have changed ~ domidle to i
(8t,wt and N~b~ -
and amend have been a bona fde resident of tbs State d Florida since ~ ~ ~ °I ~
F tPC. - isi R0 _ and i radde at S''70 S 5E79 Ara pe. L7 .
aid Nanbar)
, , e,-c ST. LUG I E Conntp, klorida.
tcw~
and this statement is to be taken as mT declaration d citizenship. actual legal residence s~ domicile in the State et Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHIt.OREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
-h~l?~n S~everse~-,
T ?ww
i
• X80 AUG 26 PN i= 5I
FIL~~E~~REtiOppFE~~COROF'0
S R06ER
POITRASA•
. CLERK CIRCUIT COURT
• RECORD VERiFIEO~
I
I FURTHER CERTIFY that I will register at mj local address when the registration books reopen. and eomplF with aD }
other requirements at a legal resided at this State. .
I FURTHER CERTIFY that I have no intention to return to m~ former domiede. and I intend to remain in
L. U C 1 E Conntj.
_ IC,t~I
Florida. permanents; . .
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Sworn to and subscribed before me this a ~ ! daj of . tC"~ ~'rc ey,,, F CL _ ~3 r~5'n
CiNiCo~A
ROGER P01 TRAS. CLERK OF CIRCUIT COC~2T ,
ST. LUG 1 E COUNTY, f LOR 1 OA ~ -
•
- • ' _ EPUTY IERK
. ROOK / P4Gf' _
,
AGO Forth 71-22