HomeMy WebLinkAbout0492 F
i
~~::;~~r~~~~a~-~ ~~~~~~:r~:: ~~~d ~~~iz~:::~si~~~,.~ ~
, 2~~498 . ;
tO "CIlI: S"I~A'I~l: A\I) C'OUIv"Il' 'I'A\ ASSI:SSO!t, ~ ~
ST. LUCTL' - J- C'O113~'1'1', I~LORIUA: ~
~7?iti is my ~lcclaratiun c~l' l)oi~iirii~~ and ('itizcnsl~i~~ in Ihc Statc ol~ I~lori~ta that 1 am r~i~~~~; ~n~s ~iay in ~
a«ur~l:i~~c~~, and in cunformil~~ ~~~ith Serlion ''22.17, l~loricla Statutrs.
1 was fornicrly .i Ic~;al msid~ni c?t - - , ~~~-~•rc~,._u_------ - - :ind I
~s~~~r)
rrsicf~d at _1~~~_-~E~--~~ . llowcvcr, 1 havc changcd my dontiril~ to ~
' (Stt.cl and NumlKr) ~
ti
ana am :+nc! ha~~r bc~:n a h~na fidr rrsi~lrnt of lhc S1atc of Florida sincc d.iy ot~
~ - ' - - - - 19_?~_ _ and 1 res?dc at _1 ~Q~-~ 43~~-
- ' ' (Sucrt and t~umbet)
• St . Lucie _ County, Floricia, ~
-~°~--Sf _-~'~``e~` ~ . ~
: n~l this statcnn~~it is to hc takrn .is m)~ dccJaratio:~ of citizcnsl~in, actual lcral r~sidcncc ai~~ douti:ilc in thc Stalc
~~f I~lori~l~. ~
(Inxri hcrc any p.rtinrnt faclc, ~u:h aa ~..Ir ut pt~.pcrty or husinrss, ur relinyuichmcnt of cmploymcnt al formcr
uoinicilr, ~emo~al of family tu ue~c dumi_•ilr. p~nc-h.,ce ~~t hume, rte.) . i
. , , -~T Tt, • H(~:~~STEAD E`:LriPTI(i`' : ~
F~:1CI.I.:G CHILURL.~ . SCHOOL. ~
If entering children in school, l=`~
please 1 is+~ their nar~~es : ~~8498
SI.C+a-.^ ST
l
C E COUMTr FLA
~i~ ROCER ~OITRAS
~~Lti~ ~h ~ _ C~ERK CLiCU1T COURT
RE~QRD V[R'FIfO
1
_ ~ 6 12 34 PN'lS
_
i
~
~ •
~ -
~
~
~
I I~UR~~III:R CI:RTII~Y that I~~•ill r~rister at my local address ~nc~n thc rcgistration hooks moPcn, and
con~~,ly v:itt~ .ill athrr rcquircm.nt: cif a l~~al r~~iclcnt c~f this St.~tr.
d
1 FUKTIIL:R CI~RTIFY thal I havr nc? in~r~~tion to rcturn to my fonnrr domicil~, and 1 intcnd lo mmain in
` ~t~ ~ ST LUCIE
• County„
Fluri~la, p~~imancntl~~. -
.
_ ~ . . _ ,~~,,LA1C?t~ 1,'~~7
f~`~`-c~- -
~ . ~ - v iL~ .?'I.T~?~-
~ j : • ~ c: _ ~ ~ - - --SIGi3t1'I'LRi.
: :
~ ' .
Sw6r.i' ;tltd~slihscrih~~i brforr me this 6-- Jay of
,
~ ~ t. - . . ~ •
" G~cu-c.~t.c~ - - - - - A. 19 ~ ~ • ~ f t F_
- ,.~i ~_n~ ress
.~GL:1? P ITRAS, c:I.::zi: CTftCU1T C~i:k'!' ~ , F].oric!~
I3 c~-l1l~c~-~~.~lleP.iL_}~ :.lerk
Y
(~o hr r~eculyd in du~~l~:atr anJ ~•~i~-in.~l ldrd ~~i~l~ l'I.•rk .:~rt ('~~url. and Jupli:alc ~~~Ih lrs Ms~a~ut)
~
O Q s
~ 5 aooK 5 PA~.t 491
;