HomeMy WebLinkAbout0922 Deci~~~~~~~r c~~ ur~~ .C~~~~~r~::~~;p ;
l~O ~~llt: S"l~A'Cl: ~~NI) ('C)Ui~7~Y'I~AX ASSI.SSi)1:, ii'^~~~ ;
S'1. LUC11; ~ ~
- - , C~OUN'I'1', LOltIUA:
'll~is ix my drrlar.iti~~n of Uc~miriic ancl ('iti•r.rnship in thc Stat~ of f~lurida lhat I am Gling this clay in
accur~lancr, ancl in cunf~~rmity with Scction "'2'. i"l, I~lorida Statut~s. :
~r - a k ~al nsidcnt of - ~~!'O r ~~N17_ L7?c//~~/~~ - and 1 ~
I ~vas furm~ I~ r r~-`-- - ~ - , -
(s~atr)
I
rrsi~l~d al ~10, t'~_Pi/yC~ ~A!!!E; . Howcvcr, I havc changcd my donr.c:la to
(tilrrrt anJ Numhrr)
ai~d am a«~I havc bccii a bc~i~a fidc rrsi~icnt uf thc Statc of I~lorida since da}' of ?
2 DNVS~4('ol~¢ Qoq ~
~ ~A~iJU AQ - - - , 19.~`'~__ , and 1 residc at -
- (Strert and Number)
•r. I ~Q('L St. Lucie Cot~nty, ~=lorida,
--C Q- - - - • - - -
- - ~c~~v1
::nd this ~tatemrnt iti to be taken as my dcc.l:iration of ritiienshi~i. .ectual l~~;al residence and dcimic+.le in the State
c,f f~lori~la. _
(In~rr. hrte •rny ~~rtliurM ~sct~, auch as ~:le of pruperty or fiulincss, or relinquish~ne~~t uf rmployment at former
dumici:c, rcmov~l uf fanul> to nr~~ domiril~. purch~s:• ~f hc~mr. ~ tc.)
- : r ~iO:~iEST~AD E~EI~1P'i'7U`i:
E*.?rttT~:G C~iILDRC.. I,~ SCHOOL: ~
If e:~terir•g children in schooi,
plelse list their names: - -
- ~'iL,~fU AN~ RE'~!
;i_ WC~E C~iN~lr F~
AOCE~ POiT~Jt~S
` RECORI' YC~!fl D~~~.~~~~~.\
~ ,~tt 9 10 z~ AN'75
E
~ ~
~ 298848
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1 FlIRT11t~R CER'fiFY that I will rc~•istrr at my loral addr~ss ~vhen the. re~~istration books rco~~en, and
rom~,ly ~~ith all other re~~!iirrm~ ~~ts of le~~at r~sident of this Statr.
I 1=lJRT11l:R CI:R"C11=Y th.+t i ha~~c no intciZtion to rcturn ta m~- for:i~~r domicile, and I intrnd to mmain in
~ ~~~Cc --ST. LUCIL - County,
~ ` - •
i•lor~da, pt.rmanrntl}~. t~~~••? S
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a _ :
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S~vorrr q fl~t~~~st~bt~ t~; ~ c,,n mc this ~ day of
~ ~l ~ .
, m~ _ , n. n. ~ ~ _~J ~ t
~ , _ ' - - _ _ ?a i ing c. re s s (
. : . ~ ; ,
, r , r• Zot
PQ7T~~1~,3'~ ~:Iti~ C KC'JT'f C~it~'"i _
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f!"'~ • 1
~ ' ~ npl1tS~ C Pr~:
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r ' ~r,:rt~=.~~ . ' ~
(Tu hc rae: ~Ird in ~fup6ralc aod ~~rr~in:~l f~trd .vill~ 1'Irrk ('ircuit Courl. rnJ ~luphc:+tr ~vi~h Ta~ .~sxsa~r
~ ~a~A235 Pacf 921
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