HomeMy WebLinkAbout1622Declarafion of Domicile and Cifizenship
~ 515133
TO THE CLERR OF T~ CIIiCUTi' OOUAT.
ST. LUG 1 E apv~y. ~,p~w;
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This is m~ deelaration o~ Domie~e and (~itisaasbip ia tbe State oi F1oTida tbat I am 5~n~ tbb dq i~ i~oooedanoe. aad i~
e~nlormit~ wttb Seetion 222.17. I~7orida Statutes. ' -
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~ 1 w~as lormert~ a kgal resident d l~/~ ~~ , /~ ~v ~~ asi I
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and am md bave been a bona fide resideat ott~ State otF7a~ida sinoe - /~ '/9 ~/ da~ d
1~ . and I reside at ~~~ ~- ~~
II~I~ ~~'E . ST. LUG 1 E~~N~
Coaat,s. ~7ori~..
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and this stateme~ is to be taken as m~ deelaratioa d dtiunship. aet~al kgal reaidenoe and domie~7e ie tbe State d~7orida.
' IF POR THE PURPOSE-OP ENROL~INC
CHIIOREN IN SCHOOI~ PLEAS~ STATE
TNEIR NAMES: _
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If FOR HOMESTEAD-PURrOSES~--
rLEASE tNECK:
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RC6EA PetTRt.S
CLE~iK CS?i'1^ t4"~' f'
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515133
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I F~IRTAER CERTIf'Y that I w~ register at m~ local address wbea tbe :rgistratioa boo~s reopea, aad oomp~ wit~ as
ot6er reqoirements d a kgal raide~ d tbis State.
I FIJIiT~R CEAT'II~'Y tba! I luv~e no iateatioo to return to foemer domiele. a~d I~ad to ~ema~ i
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F7os~ida. permanen~,'.
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Sworn to aad wbiea~bed betaa~+e me tbb ~ dq d
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ROGER P01?RAS CLERK OF' CIRGUiT COt~tT ,
~ ST. LUG i E GOUNTY, FLOR 1 UA •
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