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HomeMy WebLinkAbout1355 E~~c~~~G~i~}~~ ~f ~~~,~d~~i~~: ~:-~c~ ~i~~~~:=~~~a~~ ' ~ 2991'73 ~i~~'t ii~~ ~'rn'~ i-. ntiu c~c~un~r~' ~i nx nsst:ssc~ti, ST. 1.UC11: _ C'nUN'l~l'.I~LOI:II)A: 'llii: i~ m~~ ~irrlaration uf U~~micilr .u~d ('itir~~i~.hi~~ ii~ 1h~ Statc ol~ Fl~ri~l:i ihat 1 am tilin~; this day in acror~lancr, and in confc~rn~it~~ with S~rtirn~ ~_"_.17, Fl~~ricla Stalutcs. . ~ ~ , ~ f H•a~ formcrly a Ic~:?1 rrsi~icnt c~l~ - ...~~-1~~~ . - - - • _ - ~~~?~a.~_~_ and 1 ~ (c~ty~@/J (stat~) i f rr.i~lyd at ' . Ilowrvrr, 1 havc ch.u~gcd my domirilc to (Strert and Num'l~cr) p ai~d am and havr hrcn a hona rdc rrsi~lrnt uf lhr Stati of I~lorida ~incc -/I day of ~ 19 _ 7 . and i rrsich at _ ~ ~.~--Y~~ ~ -~L~--•- - - - - - -~L~„f.,Cy i - . . ~~~,Z ' St . I.L1C j~,Strccl and un~tx`r `Olll. y, ~Ul lt~ , • , . . ' • ~r-- - - • - - - - - ~ d ' (CitY) .:nd thi• statcmcnt is to bc takcn as my dcrlaration c~f citir..•nshi~~, .~ctua! kF~al residc:ncc a~id domicilc i» thc Statc ~•t }~luridci. (lusrr~ hcrr euy ~.•rUnrnl t~ch, +uali ~~Ir ui prupcrt)• ~~r husinr~c. or rctiuitui~h~:~ent ot r~:~pluyment at fotmrr domirila, rcnu ~at uf lamilr Ur nc~~ d~~micil~. purc:c.cc ~.t I~~~mr. rlc.) ~ E"I'i'C}:7"•C CHILDitFF:: I"` SCHOOL: ;~OifI:S'1'I;AD EXL•'AIP'rIO:`:: ~_I TL- e:iteri~~g chil:lrei~ in school, ~ ple~se list thei.r nar;es: 299~~3 ~~Gl t- r~ ? ~ L ~ , fT.LUCa! G lJMTT fLR. , . , . ; 'r R~C~= F"IT~A$ . ~ \ Ct ~ " ::,,I~i C'iURT Af..ti; _ ~ ~ I sz PN ~r5~ J Z! ' - u , ~ ; ~ _ ~ ~ ~ ~ ~ _ 1 FUKTHI=R ('I:R~1'll~l' lh:~l 1~r-ill r~;~isi~r a: nt)~ local adclrr.s ~~h~n tit~ mgistratic~n boaks re~~~,en, and ~c~m~~l)~ witli .~If atl~~r ny!iir:~nt:•nl, cif :]c~~al r~tii~tcnt of thi; Stat~. I 1=UR"1'11I:R C't:IZT11=1' th:it 1 ha~~c n~ ii~trnti~>n to returi~ to m~~ ionn~r drnniril~, and I iiitcnd tu nmain in ST . LU~IE _ Cc~u~~tv, ~ _r.._~~1-7-~_~1r..___._. _ _ _ ~ . _ _ _ _ _ _ . ' _ _ _ ~ '~'0~5T!V\ ~~I!l~411/t•~~ltl~. t'1•}~, ~ " • C : . - • - j~-- cT ~ - . . • - JJ_C*iti~ S;; ' `'ti r . . ~ ~ . ' ~ . , y - --Sl.Gi`:~!'Uiti; - - - ~ - ~ S~ti~cfcr" t?~ :~inct suh~crihrcl 1~: `~c~re s~i~ tl:i. cl:iy c~f ~ ~L.~ 6~u - _ _ _ , A.U. 1 J~ . ~ - - - '~:a~T""li,;~ re5s ~ ~t~~I::~ Pi T't'1?~,5 ~~:~.1~:!:~: ~I i:CI'~ T C.c , Flor; da ~ t ~ -r~ ____,I::.';,itt}' Clc t ~ i ~ (i~~ I.r r~ri uied ~n Jn~~1~.:~1• m.~l fd: • ~rr? t5riml ~'uurt.:nrJ Ju~.l~.:~lr ~~i~h lec A~«su~rl # eooK 235 PA~~ 1354 _ ~ ~ ~x ~ _ _ :