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~rc~ ~~~ii~: s~~ ,~~Tl~ ~\~l; (~(~1~~.~i ~i ,~`~i ~i:.
st~ .1.c~c ze ` `52282
. . _ - - _ . ('UUN"l'Y, t~ Lt1ltll):1:
'fht; ii nty cirrl:~r;~tic~n c~f I)c~n:iril~ ;uu1 ( itv.iixhi~~ i~~ ttlr Siat~ c~l~ f=lorida ll~at ! am liliiig this d.iy in t
ar~onl.~iu.~, a~ui.in confc~nnity with Srcticm ! 7, [=lorida St,~tutcs.
1~~~as fc~nncrl~~ a l~~~:~! rc~itlcnt ol' ~S J~..U~4.,_ and I
(c•~i> ) (s~ae~~
msidcd at ~ ~ _°t_ ~ ~z~~~l ~
E.~~ _ _ _ - . Howcv~•r, I havc changed my donticiic io
~ (Succt and \u+nhrr)
ai~d am .u~d h:~vr hrcn a bona Gcie t~syJ~iit of Uir State c~f t~loriJa since day of
now
-~y---~-~--------- ~ 1`-j-r1-~---, and 1~i-~~icl~ at ~'~__~._`_-~-_.~'Z3- t-~..~. -
(Street and Number, , L r
St. Lucie
1---~---~ ~?~C_- - - - C'ounty, Florida,
(c'~t.~)
and this stat~mcnt is to bc takcn as my declar~~tion of citizcnsl~ip, actual tebal residence and domicilc in thc State
of I~lotida.
(Insrri herr any prrtinrnl fact~, such as sal~ of p~operty or busin~~ lor relinyuish~nent of emploYment at furmet ~
domicilc, tcmuval of fauiily tu net.• domicilr, purchas. uf humc, rtc'J
Entering children in school:
b
~1~ om ~ s ~ ~ 1~ E ~R ~2 y
jh E1~y A, E~RnY - €
f LEO ANO RECq~ o
' S~ ~YCIE COUNTY ~A,
AOCEA POITRAi ~
" C~ERK CtRCUIT C4URt ~
RECQRO YERIFIEO...~,~.
~ I~a Z~i IZ OS PM'73
262282
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; 1 F'URTHER CERTIFY that 1 wilf T~~~i;tcr at niy tacal address ~vhci~ tlie rcgistration books reop~n, and ~
f comrly with all other requirements of ~i legai resident of this Statr. . ~
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i ~ ~
~ I F'URTHCR CERTI['Y th:+t 1 I:rr~rc ~to inieniioi~ to return to my forn~cr domicile, and 1 intend to r~main in
, . }
; t St. Lucie ~
F , t ~t - - , Cvunty, ~
Flor~~a,,;~,~r~,anenil~~. tc~~r> ~
' t;'J l : - J G C, C ~ . (
::,':.c,J~`T~.~,, O~l;;`I.- ~ - . ~ ~
~ • ~ C'•',~ - - (Name) ~
' .~,~Y ~Kt- " O'~ ~ ~ __i_~~.._ ..l-. ~~J~X \ i
~ : • i
` q ~ ° :
;~d : (aaa«s~~ !
` r;:
~~j~lq~d s~~iscribr~! brfi3r~ ~t~r ihis _~'l~ da~~ c~f ~
C:~ C ~
~
~ -_C_~~ 7~ ~
; - - n. t _ . ,
ROGEk PQITKt , CI.L'KK CIP.CUTT COURT -
~ yt-~ - - - - - -
f - b0alt~r~~ PACf
I__ ~_~C vt
; ~ ~ ~4n.~ ? C1 c~r ~
(1u B. c~rculyd m i ~;.I~:.~tr .~nd ~,ri; u~.d f~ •.o l'I~~~i ( irruit ('~+n~t. ~nJ Jupli:~lr ~cilh "Ia~ A~xctot)
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