HomeMy WebLinkAbout0921 • • ~ • • ~ ~ /
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"I'U'I IU~. ti'I~A'1'1•. ANI) ('OUN'l~Y 'I AX AS~CS~Ui~, '
S'1'. LUC1I:_ . ('OUN'1'Y. l~LOItIUA: ~g~
_ 'lliis is niy ~irclaraliun of Domicilr and ('itizrn.hip in Ihr Statr c~f I~lori~ta that I am tilii~~; th~s day in
a~ra~-~lancc, and in conli~rn~ity ~vith Scctic~n ~'2.17, Flurida Statutcs.
1 ~ a Ic ~al resi~lrnt of ~.~YIIL - , --~C~-r----- and 1
1 was fonncr y ~ ~
~iv) ~ (s~a~r) i
~ Ho~vcvcr, 1 havc cliangcd my ~lomiciic. to ~
m~i~lyd at - .
(Slrcrt and Numhcr) . °
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an~l am and havc bcrn ~t bona fide r~sicknt of thc Slatc of (~lo:ida sui~c d~y ot' ~
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- ~ - - - , 19.J.~- . and I msi~l.: :~1 ~ - - ~
(Strret and NumMcr) ;
~ St. Lucie i
- - - - Couhty, Florida, l
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:.nci !I:is ~tatim.•nt is to bc taken as my dcrlar:ition of c:itizcnshi~~, actual lrgal rrsid~ ncc and domicilr. in lhc Siatc '
uf 1=loritla. `
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(Inscti hctr any ~~~rtinrnt facts, wch as s.dc of pto{ti•rty or butiinr~s, ur rrlinquishmrnl of cmploYmcnt at fotmer
dumicilc, rrmuval of (amily tu r.c~~• dumicih, purclw~c uf hi~~uc. rl~.)
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~STi.A~ E,~TII'TT_0'~ : ~
L:: rL:.1.,~ CHILDRE.. I~J SCHOOL: ~
I f entering cl~i lc3ren in school,
please list~ t}lei.r nac^~es:
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FILED ~t~3 K
ST. t11C1E ~OUl~Tr ~Q'
ROLF~: .~.)t;R~s
, pc~cLER~~j~_F~c~; ~OURT
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I FURTHER Ct:RT1f=Y that I~vill rr;~ister at my local acldmss ~vhrn thc rcgistration books rcopen, and
~om~~ly with all oth~r rc~~uirrmrnt: c~t~ ~i Irgal r~siclent of this State. ;
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~ I 1=URTlII:R CERTI(=Y tl~at I h;n~c no intczit~on to rcturn [o my C~illll'f (IUtlli~lli. :iil(I I IiltC11(~ ~O fC1113'fl I11 ~
° ST. LUCI~ ;
- --~~2~--~~~'r' D , Co~uri;r, ~
l=iorida, pcrmancntly. (c•'"~~
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~ S~~ri~rn to :~Ud~~R~~~eJ~~f~fe mc tl?i~ day ot~
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~r R~~ . P~I~~ItA~~ ~~.~:4t1~'C }t~l]I•r cc?c;ii i ° , rl or~ d~i ~
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~ ~,~s~~'~'~;, DePitt~? Ctcrt:
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~7'n bc e cutcd in dupl~r:~lr :u~J r~nrio.il ti1rJ ~~iih l'Ir~1: C~ruut C~•utt. and Jupliiale wilh Taz A~x-csot)
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~y
6oQK~5 PACE
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