HomeMy WebLinkAbout1319• ~ • • • • ~
~?eclarai~on o~ Qomic~le and Ci~rz~nsl~~p ~~
~ 513098
TO THE CLERK OF THF CIRCUIT COURT,
ST. LUG 1 E Covt~tTy~ FLpRIDA:
(Stieet and ICamber) -
snd am and have been a bona fide resideat of the State ot Florida since ~ C~ - ~~ g~ da~ oi
~~ - ~ : ,19._L_. and I reside a! ~ ~ ~ ~117~L1~ h p~%~.
(Street and Number)
~[~ hrt ~~. ,~,1 C i L°_ ST . L UC 1 E ' County, Florida.
ICit71
and this statement is to be taken as my declnration oi eitizenship. actual 1ega1 residence and domic~e in the SLate of Florida.
This is my deelaration oi Domic~e aad Citizeaship in the State of Florida that I am filing this day in aaordance. and in
coniormit~ R-it6 Seetion 222.17. Florida Statutcs. ~
I K•as lormerls a Iegal resident of ~N" zt ~t7~ CA~~~~~ and I
. ' ICit~l (Sw,e)
resided at ~ ~ G~ -~ t~ t- ~~t , HoRever. I bave ebanged my domiu7e b
- IF FOR THE PURPOSE OF-ENROLLING
CHiIOREN IN SCHOOL~ PLEASE STATE
THE IR NAMESS
fa ~V ) j ~1 ~.ho GK
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` ~ ~ ~- ~' _ ~~ir f~~
i~~
IF POR HOHESTEAD-PURPOSES~ ~
PLEASE CHECK: r
~
1981 .! 1!~ I 2 PK 2~ I 2
FlLLC Lt:r u GOh.:-t:~
Sf.IUCiE CGU!~tY.f~A.
ROGER PQITRt.S
[LERK CIRCUI ~ CG7;T~
ac t.C.r' ~ { ^, • ~ - --
513098
I FURTHER CERTIF'Y that I w~71 register st my local address when the registratioa books reopen, and oompl~ v~ith all
other requiremenb oi a legal resident of this State.
I FIJRTf~B CERTff'Y thst I hnve no intentioe to returo to my tormer domic~e. and I intend to remain in
,~~rJ 3 r ~. ~ L,e- -- - 5 T T L U C I E , CountJ.
ICtt~) .
Florida. permaaenu~ .
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S~~'D LO,iDd 6U~1~ bCfOlE IDE thL! ~~al~ ~ ~~~ .~
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~1':t~•.•~: "''~ . ~
ROGER PO AS~ CLE K OF CIRGUI T COCdi2T ,
~ I.LERK
f _
_ :.;~- _ .: __:. -
.~::;~~-~:::._ -_ . .
ST. L E COUNTY, f LOR 10
BY: ~
~ _ EPUTY
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