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HomeMy WebLinkAbout0905 L~~c~~~•~f ~~n of [~~~~~cii~ ~~d ~~~~G~~~~ ~ i • ~ ~ ~ ~ru 7llti S"TA~r~~ ,~n~u cr~u~~~ti~ ~rnx nssi:ssok, ' ~ ~`~1~26 sT, LuciL . ~ - _ - - ~~OUN'i'Y, !•LUltll)A: ~liis is my clrclaration ol~ Dc,micilc :iml ('itiirn.hi~~ in thc St.itc o!' Flarida thal t a~n filinb this J~y in a~cc,~~la~~cr, :uu1 in co~Ubrmity with Sc~tion 2??.17, rlorida Statutcs. 1 was fonnrrly a lc~al r~ sidrnt of ~!~~QQ~_T_-____- _~~?RK _ and I (ci~r) ~s~~~N 7 rc:sidcd at ~C.i4!Y~._tg_L~ ~-~,F--_--------_- . Howcvcr, 1 h~~vc chan~;ccl n~y domicilc to (St~ect and Numbrr) - an~f am and havc brrn a l~ona lidc rrsidrnt of ti~c Statc of Florida sincc day ot~ -----~~-l~ . 19_.~~ , and 1 residc at - -~.3 ~ _ (Str~rt and Number) t_- Pj ~2~y~ -----~L-A~c E c~~~- PK St . Lucie County, Florida, ~c~~~~) - and ti~is titat~mrnt is to be takrn as my declaration of ::tizcnsl~ip, actua) lrgsil nsidcncc and domicilc in lhc Statc ~ uf rlorida. ~ accri hrre any prrtinrnt facts, wch 7!5 1JIt' uf prupr~ty or huxiucss, or rcliuyuishmcnt oi cmplo~ment at former 1 domirilc, rcrno~ al uf familr to nrtiv dnmirile. purcl~ac. ot humc, ctcJ ~ EiI'f~:':1"~G C~iII.DR::?d I!d SCHOOL: ~ 1~01`~::,~'ii.AD EXE:•iFTIO'~: ' If entering chi2dren in sctiool, please Iist t}leir nar~es: - _ ~1~ ' , Fi~fa ~~ra eF~oeofo ~ st ~uciz couHir f«. } RpGEr: ?OITRAS ' ClE41c CIRCUIT COURT ~ Acrqqn~,~Ef~iFIcD,~.~,,... ~ . 3 FE~ t0 3 56 PN'75 ~ # ~ ~ ~ : ~ - ; ; , ~ , ; ~ ! 1 FURTffER CERTII~Y that 1~~~ill rcristcr at i»~' IOCJI 3(ICITcSS ~~~hen thc rraistration bo~ks rco~~cn, an~l ~ com~~ly ~vith all other mquirenzrnis of a!<<~al residcnt of this State. I ~ ~ ~ 1 FUR7'IlI:R CERTII=Y ti~at I harc no intrnticm to rrturn to n~y former domicilc, :~nc~ I intcnd to cniain in ; ST. LUCIE I --~-L=- ~~_-~-~-E-T - ~ , ~ !tnty, ` rlorida crma~7cntly. { , .z>k'., ~ ,I ;Y;•:.. C , ~ ~ ! ~ - - .~.,''~`fiy~ ---'SIG?~:A~~~_. ~ - ~ ~ - ~ ~ " - = R~bert L. Van Vorst. ~r. ; y ~ . - . ~ - _ ' • - - - S IGI1ATUi~i: ' Swurli.Lo.:?rTi~rsubsrribr~i brfc~rr mc tliis day at ; _ ~ ~ ~~~-tz. , A_D. 19-~ ~f ` „~2 ~ " H n~ ~ - - - 2 ~ i 1.ng c1 r~ss ~ ~ ! t2nGER POI `i Rf+S, C1.I:ItK i,1 RCUI'i' COURT ' - ~ ( , rlor. id:. i ~ - ! By ~-G ~oor~~-~ Uep•~ty Clerl: (iu hc cxceutc.' in di+~~li.:~tc :md ongin:d f~lcd ~vith ('Irrk Circuil ('ourt. .d Juptierdr N~Ih : .~rssur) 800K ~V PAGE ~ . . ; - x _ ,