HomeMy WebLinkAbout0864 t~~c~~ra~~¢~n ~f ~am~cEB~ ar~~1 ~~~i~~~ship ~
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TO TllE CI.~;RK 0~ TttE C1BCU[T COURT.
ST. LUG 1 E COUNTy~ ~`LpRIDA:
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Tbis b my declacation ot Don~Icile and Cltlzcnship In ~!?e St~te ot Florida thal 1 am t'~lIag this day io ~ccordanco~ and in _
con[ormitr wltb Scction 2'.2.17. Florid~? Statules. '
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I was ior~ a k~l re~dc~t oi ~ A~,,o ~,1~[S S and I '
, " (C~i ISt+td
residcd at ir~. _ ~t~," , liowove~. I havc changcd my domicilc to
( and Number) ~ • .
and am add havo bccn a bontt fidc sesidcnt o[ the St~tc o! Florida slnce ~'-`F'`~`n~~p ~ ~ day ot
. . y9~. and I reside at - ~ S ~ ~ 11S ~ . ~
. ~1 ' ~r ~ ~ ST . lUC 1 Es~~.~aK~~~~
. \Y'.~`E' t ~ . County. Floria~?,
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aad lhis statement is to be taken us my declerRtion of citiunship. actual legai resldeoec and domicife in ~the Sta1a o[ Florida, ~
IP FOR THE PURPOSE OF ENROLLING IP FOR HONESTE/10 PURPOSES~ ~
CHII.DRCN IN SCHOOI~ PLEASE STA7E PLEASE CHECKt ~ j
7NEIR NANESt '
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I F'URTItCIt C~:RTIF'Y that I witl regi~ter at my local addres~ wl~en the registration books reopen. and corr.ply with al)
otficr requiretnents of a Icb•al residcnt of lhis State. '
l FURTIiE;t CI~;RTIT'Y that I have no inlcntio~ ta return to my formcr domicilc. and 1 intcnd to remain in
~.~1"~pl.u~~ - ST . L u c ~ E , Caon~ '
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Florida. permanenti;.
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FIIED ~k4 REC~RQED ~
~ ~ ST. IUC~i COUN71' ftA. ~
. a0~~ ~ FJ~TitAS ~
CLER1; ,~i f,vl? ~OUR •
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~ ~ " - : . ~u~ 31 I1 i9 PM'75 - ~ ~
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~ . (Name) ~ '
' . . _ ~ 1 S ~S t~l. W ~ u~ ~ ~ ~
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Sworn to and tiub~crii,ed before nu+ this ! ~ dny ot
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f:nG(_R PO I TR/~S,~CI ~FRK_ OF G f F:C Ut T GOU7T
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ST. LtK C COUNTY, F LOft 1.UA _
I3 Y c..~.-~ `~o-t-~'~~.L~ .
~f.PUTY~t.-CttK ~
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800K p~ c .
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