HomeMy WebLinkAbout0005I r tion of- Domicile and Citizenshi ~
Dec a a p
soe8oo .
TO THECLERK OFTHE CIItCUIT OOURT. -
ST. LUG 1 E COVEY, FIARIDA;
This is mp declaration d Domie3le and Citisenship is the State d Plastids that I am iIling this dq is aoooedanoe. and in
oonformkp wltb Section 222.17. Florida Sntatntea.
. I was fob a legal resident of l„Ot2 ~ [~ol,~ S , PQ~x~s_at~a~ia and I
ICk7) Itltasel
resided at b IL1 `5~a. a~~ a~E. ~ec~ooe L.S _ Aowever.I have changed ~ domie~e to
18awt aed NodRl
and am and have been a bona Sde resident d the state d Florida since dap d
.19 '7 4 , and I reside u ~~'1 ~t"w ~vl Q-~~
18trMt ass Nobwl
Poor ~C'= "l-vim.: t? ST. LUG 1 E Cooatp,l<7oeida,
Icw~ .
and this statement is to be taten as m4 deeLration d dtisenship. aett~al Legal :eodenas and domie0e in tbs State d >E7arida.
" IF FOR THE PURPOSE OF ENROLLING IF FOR HONESTEAO PURPOSES,
CHiIOREN iN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
- .~
a)Q~W
I FTJR1'IiEA CERTIFY tbst I w~ register at mp local address when the registration boobs reopen. and comply with aII -
otlser requirements d a legal resde~ d this State.
I F[JR1'BER CERTII~R t'.tat I have m intenti~ to return to ~ faem~ do~a~'k. and I intend to remain in
,T. LU61 E _Cplmtp
ICit71 •
F9orida. permanensi; .
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X980 OEC - ~ AM ~~~ 20
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as d ~ `~Uti-.~L. Q S~ - ~.~.
sworn to and sobeeribed before me this p
rC~.c2~,~•-Q.u- - A.D. i.~ E Rw iA! oad -
Ce /esre ANN auTTeR~
ROGER P!01 TRAS, CLERK OF G 1 RGU 1 T COldtT ,
ST. LUG I E COUNTY, f LOR 10A - ~ -
E P U T Y lt. E~-.~_ `
. - ...
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