HomeMy WebLinkAbout0974 ~ Deciaration of Domicite and Citi~enship ~
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T01'H~ CLERK OF THE CIRCUIT OOURT. .
ST. a~ ~ • OOUNTY. FI.ORIDA:
Tiiis V m~ deelantjoa of DoaJeD~ aud CitlunsAip in tM Stat~ ot Elorida that I~m filias thi~ da,~r ia ~ecordancs. and ln
eonformit~ ~riti~ S~ttbe 222.17. Fioridi Statut~s.
I was torme~ a k~al resident c~ .~s a.. 1/os~ ~C ~ ~~s c.. a/~ K and 1
lGt~l IStaul
. c~sidcd at 3 00 ~01 T~~ ST. - T. /~L ''L . Nowever, I hav~ tbanred my domic~7e to
latrs~t a~/ Niu~Mr! .
and aa~ aad have beta a bona bdt resi~aS ~ LAe 3tab oi Fbrida slna~ `7r~t T'•~+e ~i/
i~t ~ dar o/
/~r'~~/ ,1~~3 aad I re.ide.t 7S~ 9 Sw Iv.o = So~v ~~ve v
) . lSe+..t a~d N/umD~!
~o~ T.ST• oC4 ~ s7
: oS4 G'i s. Couaty. Florida.
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and this statement b to be takea as m~ deduatioo o~ dtiunsAip. adual l~sal re~idenc~ aad domia7s tn the State af Florida.
If for the purpose of enrolling
children in public school, please
state their nanes:
'i
;
~ I FURTHEtt CERTIFY that I wt11 resister at tar loca! ~ddress when t!u registntion books rcopen, .nd coroplr MitA aU
~ other nquire~aenti d a k~al nsideat ~ thif State.
i
, I FURTHEI~CER~ ~bat ~ have ao intention to rcture to m~ former domic~7e. and I intend~ to remain in
~'fs s ST s~4 c~ s Couot~.
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; Florida. permusentb.
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S~?orn to aa~"wbseribed belore uK th» ~ da,~r 9( ?
. Name - si~n
' A.D. i~ $ 3
~ ROC~~t FOITRA.S . QERK CIRCUIT OOtJRT Name - print
' ST CIE COUI~IY , FI~ORIDA
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Deputy C er
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