HomeMy WebLinkAbout1668 D~cl~ratian c~f t~arnic~~~ a~d Citiz~r~~i~a~
~ 263518
~ro •rtt~ s~~n~~~~: nnu covr~~~Y •rnx nss~:ss~iz,
St.Lucie
_ COUN1'Y, I~l.Olttl)A:
Tl~is is my ~lcclaration ~f 1)o~ni~ilc an~l Citir.ri»hip in thc Statr of ~lorida that I am tilin~ lhie day in -
accord:~nce, and in conforn~ity ~vith Sc~tion ~?~.I7, I~lorida Statutcs. ,
i was fornicrly a lrgal residrnt of L~-_ , and 1 '
(CiIY). (Slate)
residrd at _ ~'01 o a~ i
R~ ~ 1/ However, I liave changed my domicile to
~ (Strcel anJ Numbrr)
and am and havc becn a bona fidc residcnt of tizc S:stc of Fl~rida tincc day of
now . `t ,
_ - - -w ` , 19 , and 1 /~resicic at ~ 1/~~ 1
- - ~ ~ _ _ _ _ _ . - _ (Street and Numbcr) _ - ~
~j~ 1~,Q~,~~ . St . Lucie County, Florida,
~ (c~~r) ~
and this statemrnt is to be taken as my declaratioi~ of citize»sliip, actual legal residence and domicile in tlie State ~
of Florida. . ~
t
(Inseri here any perlinent facls, such as xale of praperty or business, or refinquishment of employment at former
domicelt, temoval of family to new domicile, purch:~.ce of home, rtc.)
26~8 "
Entering children in school: i~~Eo ~MO RECO~tDEp
. aT. LUClE COlfATY flA. -
~~,'~Q,~ , aOGER PO~TRAS
'~1~"' ' CLERK CIdCUIT COURt
. J RECOR4 VERIFIED.~,.~~ ~
~
_~"Dy""~°`' S~ i1 12 s~ PH'T3 ?
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a.,, _N~,~~,
o~n,
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l FURTHER CERTIFY that I w•ill register at my local address when the registration books rcopen, and ~f
comply with all other reyuirements of a Ic~al resident of this State.
~ ~
I FURTHER CERTIFY that I h~rve no intcntion to reiurn to my fomier domicile, and 1 intend to remairi in ~
/ ~,c~t~•c~C.. _ ~ ^ St . Lucie , County, '
Florida, permanendy. (c~tr)
. ~ i ~ ~ ~ e ; i
_ .-~~~=_~_'~C: - - ~!_~C.~~fS"~ '
_ _.1 r~~:. ~ (Name) i
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: ~ : • T~: . ` ~~D ~ ~ `I~ n
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~ (Addres~) '
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~ocn.(o.~n' sutiscribcd hcforc mc thi~: _ J~y of :
irl . 3
. 1
- A.1). 19-- 73_.
RaGER POITRAS, CLERK CJRCUIT COURT
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(Tu IK- c~rcuf~•J in dn~rl~retr :~t+rl .,ti~~n,rl :r).~J nUh !'Irsk ('~n uil ('uurl. anJ dupliratc ai~h l:+i
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