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HomeMy WebLinkAbout0958 ~~c~~~~~ior~ Qf ~~rr~~~;i~~ ~nd Ci~iz~~~s~~~ '1'U'I~lll: S"I~A~'I: AAt) C'UUh'Il' ~'I~X ASSI=.SSOIt, ST. Li1i.7E-- ('OUN'1'Y, LnR1UA: • e~{~~'~~a3 'llii, i. my drrlaratiui~ c~f Uomicil~~ an~l ('itir.enship in thc Statc of l~loricl:i th;it I am tiling this day in :~rcc~r~lancr, ai~d ii~ conformity with Srctio~i ~?'.17, I~lorida Staluhs. ~ I was t'ormcrly a Ir~;al r.•si~lrnt of -~-~--~--?j-?~'~~'_'`~~- ~GE'!~C/ - and 1 . ~tc~~~•) ~~tr) ~ Y- rrsicicd a! /_1__L.__ __~~~1_~G~~-.-_ - . 1-iowc~~cr, 1 have chsngcd my doniicilc to (Slr nd Num cr? ' ? .u~d atn and h:~~~r b~cn a ona fidr rcti~l~nt ot~ thc S1atc oi' E~lorida since --~~~Z~___ day of ; ~ ' ~ ~ , l ~l_~~ a~:d I residc at ~~~.~fil/ G'~~~- _ . ,5~ - - i - (Strret a d Numbrr) ` St . Luc ie - ' c _ J/~..-/zl~_<-~~~~„~'~.e-~--- - - - County, hlorida, ~ - - (c'it y ) ;:nd this ~t.+tcm~ nt is to Ur takcn as tj~y cleclaration ot~ citircnship, :1C~l1~ll Il'~,'~1I iCSI(jC11CC ifflC~ tjU11UC1IC ~n Utc Statc ~,f E=loricla. . 1 (Inscri hr~r any pertinrnt :.~ctc, ci~ch ac +:Jr ~.f pr~~pr~l>• or bwinetic, or ~elinyuish:~~rnt cif rmployment at fonner domicilc, rrmu~al uf f~n~ily t~ ne~v d~.~n~i~ ilc. ~~urct:acr uf ho~e:r. clr.) Er1TCit3''G C?~ILL~R~i1 I~: SCNOGi.: ~ !~0?~~.S'I'~At~ E`~EMPTIO`I: If en:.eriiig childr.en in sc~ool, please Iist L-hei_r names: . ~ . ~ ~ - - Q~~L - i:i~ ~ /,l z ? / /_7 ,~S . ~~i i ~ ~ / / / ; f f ~ ~ ` ~ ~tf CSt~7lJi~ ~ g _ GHt? 9vfift,~; C tt~Fx E: :ct~{, ;.~t \ ~ ~fC~k~ YC~'f~~~ ~ = 1~t 4 os ~.~1'1g ~ ~ ~ , ;f ~ 3U344~3 ~ ~ • 1 I~tiR"flll:it ('l:h'i IF~' tt~at I~vill r~;~i~t~r at m~~ loral a~l~lress ~t~hrn the mgictraiion boo4~:s rco~~ci~, and ; cazs~;l~~ ~~~ith all otlzrr rcc~!iiremc~~~[s c~f a 1<<~al r~~.id~nt of lhis St.~tr_ ,a ~liRTilt:R Ct:R7'I Y that I I~:~~~e no intcntio:~ to mturn tc> >n}• fonncr cion~icil.~. .;r~d ( int~nd to rcrn;~in in ~ ~ ~j'L ST . I.tjCI~ ~ ( o in~v -'~~~~?2 - - • - ~c,~ - - I~loiicla. {~~~r~ii~nentlv. ~c~~~~> s t,..s~.. . ~ ~ c~ ~ i ~.'-~-~'l t . - - ---s ~~A~r - - - ~ , J " , : ..~ll- - - ' • - c . S i~~ I'iJR~: _ : ' ~ ~ ' ` ' ~ / _~-~ft-~ ~ ~j' = S~~~c~rn tQ .~nd.~~F•sCri~ ~-~rforr mc ilsis _ _ ~l.~y of /~~'n.-~ ~ e, . ~ LL; ~I. • .r ~ ~(I ~ ~~F'~ ~~`T~ _ - . _ _ ` - - - - , A U. 1 c) _ _ ~ • ~ a~_ 7l~Tc re s s _ _~_~c~ ~ iiCK~ER ,I'OlTitl`.S, CITi:K kCll1T C;(li1KT ~ rlorid~ - - - ~IP~ }i ` 1 e~~ut-}r C?.erk Y ; (To he r~r t~•d in Juphc,tc and ~n~~-ina1 f~lyd ~+ili~ ('I:tA l'irc~nl ('.,lirl.:~~id dupnc.~tr ~~~il, 7:~~ AsuSS~~r) - - s~~ ~37 p~ 957 - %;e - _ - _ ~ - _ - , - - S _