HomeMy WebLinkAbout0779 Y"
D~~f~ru~~an ~,~?f ~~c~ic~;~ a~~ C~~~~er~~he~
rc~ ~rtii: s~i~,~-~-i~. nr.i~ c~au~~r~~ ~r,~x ~~~si:ssu~i. 262898
St,Lucie
- - _ C'C)t!N'fY, i=LOItll)A:
't~l~i. i~ my clrcl:~r:itio~i c,t~ Uomirit~• and ~'itiz: ushi~~ i~t thr St:+t~ c~f I~Ivri~la llzat 1 ait~ 111lI~t this ~lay in
-~~•<~~?r~l:+ncr. :~n~! in coul'ormitv wilh Sr:cti~~~ ! 7, 1=1c~riil:i Statutrs. ~
~
1 ~vas forn~rrly a 1 ~ ~a! rrsicirnt of ~ - _ 5 , _ ~C~ and 1
p/, _ 'il>;). ~ (StstE)
residrd at ~-2__ ~ . ,
-~l-7 t~~~!L~_-_?~--L _T____...____ . Nowc~cr, I havc chan ed my domicil~. ta
- ~ (St~rcl and tYumbtt)
and am and have bcen a bon.i Gdr residr~it of the State of I~torida since _ day of ~
T10W r.
- ~ _ , I 9 ~3
` , and ! ~residc at ~ J_~~1_'-Jl-~ ~p~-c.-~~
(Street and TVumber)
_ , _ , St . Lucie Couniy, Florida,
~c~~r)
and this statement is to be taken as my declaration of citi-r.enship, actual Iegal residence and domicile in the State
of Florida.
(Inseri Aere any perlinent facts, sucfi at salr of pruperty or business, ot relinquishment of employment at former
domicile, rrmoval uf familv..to new domicile, purchase of home, e1c.)
Entering children in school:
f 0 AND ti~CO
; , 4tIC1E COUMiY ~
ilOCE1i POITl1Ai
CIERR CIRCUIT CO Ilt t
RECOR~ YERIf1ED,~...,.~~.
~ 5 112e PN'T3
2s2sss
~
,
~
I FURTNL'R CfiRTIFY that 1~vill re~ister at my local address wlten the registration books reope~~, and
comply with all oth~r requircmrnts of a le~~al r~sident of this State.
FURTIIER CI:R FY that 1 have no intention to return to my fonner domicile, and 1 intend to remain in
.
' ~ ~ . St . Luc ie
- - - County, ~
_
Florida, perniancntl~~. ~c~~~~ L i a~c~ N_ 5.
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~'s~p~ ~ l~Rith~cl brlur: mr t1ii, ~i:~y of - -
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:~r~r~~::~GB: _ v-r.~-7_- A.I~. 19 _ 73_-
_ r~ - : .
~kE~I~R.. P(3IT~tl3,~,', CLERK CIN.CUIT CQ1J~?T
- - - - - - - -
_ ,~y ' m` georc~~$ ~
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i)e t ?~1 _ ~
( f~r hr a~c~u1rJ ~n du~~lr. atr .~:id .~t~?• ~I 1~!. .S ~•.ilh l I, ~ l ('~~c t~il l~~~url. :u~d Ju~~li~ :~lr ~vlh 7:r, i..•.ct_~~t)
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~sy" Mr~v,.F.:l . . . , c:X~ da.i, a~C'~73".C~~