HomeMy WebLinkAbout1641 l~~c~~~~~a~n o~ C~ami~~ti~ C~~iz~ns~-~i~
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c~ it. s~rn~rc nnu c:our~-rY ~rnx nssi~ssok, 29'7,^,1fi
ST. 1.UCIL __~•vUh-~'1',I~LORII)A: ~
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11?iti is my dcrl:n~ation uf Don?icilz• .?nd C`itizrnshi~~ in thr_ St:~~~ or r•i~~;,~:~ th::t I ain ri~~~~ ~t~~s aay ,
:,;rurJancr, and in conforn~ity witit Scction ?2?.17, Elorida Statut~s.
N. Y. 1'~
I was Ponncrly d I~~a! residcnt of NeNbittsk _ and 1
(CitY) (Slale)
RD#2 Moorea Hi11~Ri.
r~.idcd ai . Howc.ver, I havc changcd my domicilc t~~ ~
.,~.,r. (Streel and Number)
;,nd am .,nd havr tx~n a bona tidc rosidcnt at thc State af florida sincc 8~k day of
Dea. 19_~'~? ,,nd 1 rrsidc at __750 ~`r!blin_Rli~ Ri. e/o R. Wolf
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F ort Pierce- .`-_--St. Lucie ~ County; Flori~a,
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o he tak~•n as m declaration of citizenship, actual leaal rrsidrnce and domicile in the Statr
~,nd th2s stat~mcnl i~ t Y ~
u(' f=loric!a.
;
(I:wr: hrrr any ~tinrnt facls, such ac sa~r ot pr.~perty ~x busiurss, or rriinyuishment ot empiuyment at former
dumi:il~, removal uf tain~ly w nc..~ d~~mi;ile. punhase of hutnz. rtcJ
, , ~ . x~r~:STEAD E.~E~IP~rio~y: ~
F?•~ i~;:I.:G CHI~.DRE:~I I~~ SCHOOL.
If entering children in scfiool,
please tist their names;
Barr~ R o~ Conzales
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1 FURTUrR CL'RTIFY that 1 will re~istcr at my loca) address ~~~hen Uie rcgistration books reopeiz. and
rc~mply with all uther reqtiircments of a le,al rrsi~ent ot~ this State.
1 FURTHER CI:RT1rY tli~?t 1 ha~•c no inic~:tion to return to my forn~er domicile, and 1 intcnd to rem~in in
ST. LUCI~ County,
I~lorida. pennancntly.-----~c~tr) -
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: ~n c .-a -
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;in~ bsttt~,~d b~(~~rr mr this day of
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_ . ~ z A.D. 1~~ _74-_. ;
- i ing ress
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~e~!~`~RA;, Cf..E h CI::CL'7T Cn'_1RT , I'lor. ~.d1 -
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a c_ _ DE~uty :;1~•rk . •
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( ~:-J ir cicpl~:a~c ard uriFin.~l ~•1~ d~.:'!~ ('I ~ik l'ircail ('ouH. aaJ ~I~pl:~ .Hr v.ilh Ta~ /ltiuswt)
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