HomeMy WebLinkAbout0054Declaration of Domicile and Citizenship `~
508829
TO THE CI.ERR OF THE CIRCUIT OOUItT.
ST. LUC 1 E apv~y. ~,p~A; `.
This b mT declaration at Domidle and is the State of 1:7orida that I am IDiaE this dy is aooordaoee. sad is
o~formitY with Section x.17. F7oeida 8tatvtea.
I was i~ a legal resident of ~F 5/p0/t~ j . y EW ~ y~E/~sE7 ~ I
Ipt71 18eaW
raided:t 1 f 3 c~//VG~4,~'o/?A ~4vE' '
- However. I have ehaoged ~ domidle to
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and am and have been a bona Sde rseidsnt ottM State dFlorida siaoe dy of
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and this statement is to bs taken as mT deeLratioa of eitisenship. aetaal legal rssideaos sad domieOs in the Stets of >z'ioeida.
" IF FOR THE PURPOSE OP ENROI.t.ING IF FOR NOMESTEAD PURPOSES,
CHILDREN IN SCNOOt., PLEASE STATE PLEASE CHECK:
THEIR NANESt
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f~~t/y/ Fl- ~c/S/(rvc~Oz a CLERK crtce~
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I FURTHER CERTIFY that I wiD register at nq k-aJ address when the registration boob •eopsa. sad campy with all
other regnirrmeats d s bgaf r~aident d this State.
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i I F[JRTHI:'R CERTII~'Y that I bare ao intention to return tom former do~mieile. and I intend to rennin in
U C 1 E - Connt~.
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Fbrida. permanenti; .
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Bwora to sad subscribed beto~+e me this / daj at _/" ~~ T s ~ L ~ ~ / C _ /- L /~.
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ROGER P01 TRASH CLERK OF CIRCUIT COtdF2T
ST. LUG 1 E COUNTY, FtOR 1 OA
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EPUTY LERK
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