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HomeMy WebLinkAbout2582a Deciaration of Domicile and Citizenship ' 515'7'~3 TO Z'HE Q.ERK OF THE C1RCUIT OOUAT. ST, Ll1G 1 E apvl~Tr, FLOx~a: ~~ 11~is is n~ dse4ratjoo oi DomieDs aad Qiti~emtiip b tLe Stat~ d~7orida tlut I am ffis t~s d~ is aooor3aoo~. aaa b ~onto~it~ witD Seetioo 2?2.17. P~orida Statue~s. ~ ` I was lormerl~ a k~ai reside~ d ~' ~~ F~v ~c /V •~ aad I 1~141 ~~e'r'~1 . resided a~ o o/-,r ~~~a ~ c~ ~/~- . Ho.e.et. i ba.e eban=ed bv domoc~ete 18t~sd a~dl~l.~6~e1 .aa.m ~ah.~e~.~ sa~~~~r~s~~r~a~~ /`t'a -~ ~ 1< z ~ a.~.c z ~ ,1~ g' ° - ana I ravde st ~ '~ o ~ S • ~. . S ,- !:. ,r F ~c ,+~ -r~ (~ a.~ NsM ~.,r.7 S7, .~ ~ e: e _ ST. LUG i E ,~, ~7or~d~, ~c~ and t6is statement is to be taken as ~ dee]aratioe d dtizensbi~. aetwl kaal resideaoe aaa domie~c a tDe &at~e ai ~7or~da. ' Ii fOR THE rURPOSE~OF EMROL~INC CNILDREM IN SCHOOL~ PIEASE STATE TMEIR NAMES: ~ ' ~r IF iOR HOMESTEAp~rURrOSES~~~ ~~e~st CHECK: x ~ ~ ~961 FE3 -3 . PI! ir 33 ~ FtLf C ~ti[ '= CLNJ~ i sT.~i~rt cr~r:-f F~ ~ ~aG~ PC11R~S_ ~ -- : C~f ~!! CtRC^i. ~ ~ - i Sl5'7'~3 I FURT~i i~RT1I''Y tbat I w~ register at a~ loca] addr~w wiw tbe regisiratioe boot~ ~s, aad ~om~j with a~ otber reqmremed~ d a ieaal r~aideat d tLis Stite. I FUAT~B CERTII~'Y thit I ha~e as ~ r~et~ to ~ iaimer 8om~ele. a~i I bteaa te remai~ b ~ , CoaeR,~. .. ~p~ . F7orida. perma~,'• ~~, co~Nry <~`` -~~ ~~ ,'~ ' . i~ ~L. '. ' J i `~ -.~... \ _ - ' ' , -„ - • _ • ='`~ l.I ~Jt--~ 1~ _ .~ -~, -~~•~Q~ ~ _ ~r _ ~,3 ~Y nES~ <' /~ ~ (i' f4 rl a - ~ F Swoc~n t~o aad sob~bed beia+e me t~ ~ dq d ~ - ~ - ~ ~,~-~.-~ ~ ~~._ / 98I ~ P,QljRA$, CLERK OF CIRGU{T COt~tT i ~ ST. LUG i E CDi1NTY, fLOR 1 OiA •~. - BY: c.~ , ~~ . E~uTY ~.IERK ~3~7 ~2575 ~ ~ ~~.~'z`~., r~wa..'?~-+__.'~.~~T cX.'=~e- ...-.- ~/`-~~ . + ~,~~ _ -~' :. ~ ~ . -_ ; ~ ,r ~ f ., . ~ ~ _. ., ~~~ . . ~.-J:~e`"`~w`~~