HomeMy WebLinkAbout1218
f
Deciaration of Domicile and Citizenship
. ~
51~.328
TO THE CI.ERR OF THE CIIi(.'tJ1T OOURT.
ST. LUC 1 E apv~. gj,p~~;
~
~
T6V is m~ declantion ot DomicDs and (~ti~ashiip is tDe State d~'lorida Uut I aan SNns t~ d~ in aoooe+daaa. aAd b
coniacmit~ witb Seetton 222.1T. F7orida 84tut~s.
I was forme a kgal resideat o[ aad I
~7~3 V(~Q I~G~ ~p , ~~~ ~~
resiaea .t ,.____ flc..e.et. I t~s.. ebaagsa aq aomk~. to
(BtrNt a~d N~ba) Q
aad am aad hsve been a bona Sde reaident ottbe State dFlo~ida~sinoe /~ . dy a[
19~. and I reaide at Q~.1 w ~~
' (8trwt na Na~~rl
, ~ ~ ST. LUC i E ~~g~~
tcw~
aad thi~ stat,ement is to be taken as m,~ dee]antios a[ eiti~eash~p. utual legal reaidenoe aml domie~e io tbe BLate d FSorlda.
, ' IP FOR TNE PURPOSE OF ENROLLING
CNIL~REN IN SCHOOL~ PLEASE STATE
TMEIR NAMESt
IF FOR NOMESTEA~ rURPOSESi
PLEASE CHECK: ~
~
- ._
~sao oL~ zz ~ ~r 27
Sr~` QER~POITR•A t.A. _
CIERK CIRCWT t01~~
~~r.na~ ~~c F:~~t ~__~ _
511328
I FURT~R CEBT~'Y thst I wDi ngister at m~ bnl address whea tbe registraLioo boo~~ reop~a. a~d aompl~ wki dl
otber nqnQemeab d s kgal raideat at tLis State.
I FtJR1~ CERTII~'Y tbat I 6a~e a~ intention to raturn to icrmer domie~e. and I int,e~nd to remain in
, ~ ~7
(~t4) . ~
_ I~'lo:ida. permana~i.
~4'~~Ulyl~,c ~
c .' a~ :~ ~~~
U; :~ ;~ ~ ~ii
uj, ~. ~ ~..a,lf~3/ ~ ; Q~r n _
~/i ~'••":....._..• ~~p ~K ~
~'F counTr.F` ~ ~f
INa~
8woen to and snb~aibed betae+e me t~ ~ y daj d
.
I~g c-~~~.oi-- A.D.1~~ =
R~R PQj_~RA$~ G4.ERK OF G iRCUI T COl~2T
ST. L l1G 1 E GOUNTY, f tOR t OA •
. ,
- - BY: ~/1~~c~
~~~ .1~EPUTY ~~ERx
..
. .~~
. ~ ; ~
-s ~~ 5 p,-~~Zi~ '. .
W~~ j ~-'
. j
Af,n F~._ ~?I ?1' ~