HomeMy WebLinkAbout0946 ~ ~
Declaration of Domicile and Citizensi~ip
TO THE CLERK OF THE CI1tCUJT OOURT. .
S-~' ~ ~ J C' OOUIV7'Y. FIARIDA:
Tbi~ is my deelarstloe o~ Domkfl~ ard pttunshtp in tM Stat+~ ~t Florida t6at I am tilta~ thii dq ta scaordane~c. and in
eQnformK~ witb S~etio~ 22Z.17. Ftortda StatutM.
I wa~ torn~e a kpl resid~a~ af . ~('r~~C'_(' 1 G~ and I
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resided at 1 S(`, p~erer. I Mv~ eh~n=ed m~ domic7e to
1lt+~~t A1~Mrf
and am and have been a bona Sde rtiid~at o[ tbe 3tat~ ~ Florida sina •~v ~ T v~-~~ l~ g~ da~ at
i~_.. and i rosid. at ~ p ~ G 1L O ru ~~r ~L,P
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and thu statemeot ts b b~ takta iu m~ deeLr~tjoo ot citisensUp. adwl ksal residene~ aad domk~e in ths State ot Florida.
If for the purpose of enrollin~
children in public school, please
' state their nanes:
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4 I FUR7'HER CERTIFY that I rvt7! register at mT loul address wheo ttu re~iatntian boolc~ reopen, and cocnpl~ .rith all
r other requiremenU a~ a k~al te~ideot of tAis State.
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~ I FURTHER CERTIFY that I bivt no iatention !o reture b m~ ioraur domic~7t. and I intend b rrmsia in
' • ~ t F P , ~ -i- L ~ c_~ ~P - Count~.
~ Ipt~) . 6~~~
~ F'lorida. permanectl~.
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~ 1983 ;,'I~ -9 PN 3~ I C~
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Sworn to and aubxn'bed Eefore me this ~ day 9[ ?
. Name - si~
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ROGF~t POITRAS . CIERK CIRCIJIT ODURT p
Sf . LUCIE COUIvIY, FIARIIYI
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De~nity er
B(lOK P»i~E 945
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