HomeMy WebLinkAbout2762Dectaration of Domicile and Citizenship
' 515815
TO THE CLERK OF THE CIRCUIT OOURT.
ST. LUG 1 E apU~y. ~,p~A;
7Lis fs m,~ decLration ot DomieDe and C'iti~ansbip in tbe State ot Fbrida tlut I am ~ this dy ia aooosdaoa. aad b
oontormit~ wttb Sectioa 222.17. I~7o~rida Statutes. ~
~ I was former~ a k~aa1 resident d~~ L~- ~~ RT -~111:r w~~~ aad I
lGt~) lBtaW
resided at ~~,~t.r° L . Ho~vever, I bave ebaated ~ domidk to
(St~t asd I~l~sb~t~ /Q -
aad am and have been ~ bona Sde nsident of tDe State otFlorida sinoe ~/C• i ~~ dp d
~ T 1~~4~ and I rc~de st I dL [o ~ ~TTC. FS ~S LA IV ~
l8t~t ~ed Namb~rl
~~(1JS~/v e r4-Lr 4~ ST. lUG 1 E ~~~,~,,
~c~v~
aad t6is stateme~ L to be taken sa m~ deeluation d eitiunship, actual kgal residenoe and domi~e in tbe 8tate d I~7orida.
" Ii fOR TNE PURPOSE~OF ENROLLING
CHI~DREN IN StHOO<~ PLEASE STATE
THEtR NAMES:
.-
- ~r
FILEt~ ~hf F! CUi~:-! U
S1. LUCIF cou~ t Y.- l a.
ROGER POIrR.ns
6lERK CIk=U:i CGU"1~
~i: /J~{'~i ~~' 7::' : ' . ~ " "
515815
I FIJRT~~R CIItTI~'Y thst I wID ngister at a~ loeal address wben tbe ngistration boob teopen. and eompl,~ wEtL a8
other requir~me~s d a kgal resideut at tbis State.
I FtJRZ~ CEltT~f that I 6are no inteatioo to r~etnrn to ml ~lorm,er~~ domieDe. and i fntend to remaia is
, .--~"e~ - a~.S~l..~ , Co~antJ
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F7orida. permaneat~;. -
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~~~a~ C~ERK QF CIRCUI T COt~2T
ST. Ll1G 1 E COUNTY, FtOR 1 OA •
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a~347 PA~2755
t981 FEB -4 A!! i~ 39
I f iOR HOMESTEAO" PUR~OSE ~--
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