HomeMy WebLinkAbout0769 D~:~f~?~G~~c~n a~` C~~~n~c~~~ ~~~d C;:~~z~~~t~i~
~ic~ ~rii~: s~r,~~ri~. ~~nl) (~OUn"l~Y ~rnx nssi~s~c~it,
St.1.uCie _ _('OUy'1'1', I~LURIUt~: 26~~
'llii~ i~ ~»y ci.•clai:~lio~~ c~f I)~~~ui~ilr :~n~i ('itir~nshi~~ in thr St:it~ c~f I~loricla ihat I an~ ~ilin~ ihi, duy in
aa•~r~tancr, .irni in cont~~rntit}' ~vilh S~cti~,i~ ~~'2.17, Pl~ri~la Statutc~.
1 w.~s fonnrrly a h~al rrsi~l~nt of ~~~~1~1 ' and 1
.
(Cil~~). (Slale)
resided al - 1-.----- However, 1 h~ive chan~ed my domicite to
~ (5ttrct and Numtic?~ - - _
- - - _ _
and am and havc bcrn a bona fidc residcnt of the State of rlorida sincc day of
- - , 19~~ and 1 ~owdr at ~ ~ ~d O / ~ ~ ~0 7~-t E
~ (Strcet and I~umber)
• ~e rC P_ St . Lucie _ County, Florida,
~ - -
(c~~Y)
and this statemcnt is to be taken as my declar.ition of citizenship, actual hgal residence and domicile in the St3te
of Florida.
(Inurt herr any pertinent tacts, such as xale of pruperty or bucinrss, ur relinquishment u( employment at tormer
domicile, rrmuval of faic~ily to ne~~~ domicile, purchrsr oi home, rtc.) "
Entering children in school:
.
,q-i2 ~on~ /~i iY~' ~2
~
rILEC ANO RECORpEp
ST_ LUCIE COUMTY fLA. ~
~ , ROCER PO1TqAS
CLERK CtRCU1t COURT
RECORO YERIFIED
` SEr S I I 36 AM'?3
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~ 1 FURTf1ER CERTIFI' that 1 will register at my local address when the registration books reopen; and
~ comply with all other requirements of a lr~*~I msident of this Statr. ,
~ I FURTHER CCRTIFY that l havc no intcntion to mturn to my fonncr domicilc, and 1 intcnd to rcmain in
~ T /"/ei'?C~ _ St. Lucie County, ~
~ - - -
~ l~lorida cri i:~ (c-+~r)
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~ S~so~si ..~~1c~s~:l~srrifi~ci brfc~r~• mc thi: d.~~~ of
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~ - - - - - _ A.t). 19 ~_3__.
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~ ROGCP. POITRA CLC}ti•: C1i~CUIT Ct)URT
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