HomeMy WebLinkAbout0170 Declaration of Domicile and Citizenshi
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498525
TO1~ G'LEtiE OFTHS (~CUlT OOUB'1'.
ST. LUG 1 E OOVid'1'Y. FLOiIIDA:
pia b q ioa d DomieBe asa Glitbaaaiip b the. i3lala d I~forida that I am iI~ thb dq b aoeoedasa. aad in-
• ooa~T ~ Soet3ow !lt.1T. Florida &atat~aa.
Iwas i4r~ a bpl=aoidaetd v~ l'~a ~a ~ - , ~L4.. and I •
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reaidod at How~aroa. I haN ehaeGed aq domie~a to _ !
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aad as aad saea bees! abon Sde=eaidaart dtie i3tatedl:7oeida aiaoe •,•Q~ dy? of
1~ 5fo _ aad I:eoido at 3 !~O ~J SD . -~Nd iC~N ~~U ~/2
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• ~?@l2C~ ~ _ ST. LUG I E
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aad tab atatesaalt is to ba tahos! as aq doda~atioa d dtisem>~. aatoal asl rMidenoo aad domieiie itv tae ~ d 1:7sarids.
- if FOR THE PURPOSE OF ENROLLING IF FOR NOMESTEAO PURPOSES,
CMILOREN IN sCNOOL, PLEASE STATE PLEASE CHECKS ~ i
THEIR NANESS [
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I F[JB1'l~B (~itTII+'Y that I wig s; alq lonl addeeaa wawa tae i~ratioa booiu reopes. aad oomipl, with aD
~ daesr rpoiessDaada d a assal teaidrat d tab State.
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i I FtJA1~B CIOt'1~'Y that I Sara so imtntion to ret~a to farmer domin7e. and I blend to ~ remain b - a
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ROGER P017RAS. CLERK OF CIRCUIT ~OtdtT -
ST. LUG 1 E COUNTY, FtaR 1 OJ1 • ~ • ~ _ -
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- EPUTY LERK ~
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AGO Furr,. Tl ?2
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