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HomeMy WebLinkAbout1698 H~~~E~rG~i~s~ ~o C~~e~~~~l~ ~~o~ Cc~o~~~~~i~ .~~gg~u . . . . . ~ , ~ . . ~ ~ TO 7'lil~: CL~:RK OF'TlIE CIRCUIT COU1tT. ST. LUC f E CovrrMr, ~.onlnA: . . Ti~is Is my dcel~~elton of non~icile and Cilizcruhip in tho Sl~to of Fiorid~ the?l 1 am liling this d~y t~ accord,~nco. ~nd in , contormity with Srctioa 2y2.17. FloriJa Sututcs. , ' . ' . 1 w~s ta~mcri ~ icg~l reaidc t ~ and I 1 lState) residcd ~t . liowovcr. I hsvo chan&cd mr domicile to . ( Nurab~rl ~ a nd am and hRVe n a bona lidc rcaidcnl oi the SU?tc of Florida slneo dar ot ~ ~ - l9 / ? - ~nd 1 residc at ~ - • (Street ~nd Number) • ST. t_UG 1 E Couaty. Florias, ~ l~7) • - ~nd this statement is to be taken u n~y declaration ot eitizenship, eetual legsl residcncc and domieile in the Slnte ot Florida. ' If POR tNE PURPOSE OE' EHROlL1NG . IF POR NONE57EA~ PURPOSES~ CHIt~REN IN SCNOOI~ PI.EASE ST/lTE Pl.EASE CNECK: ~ THEIR NAMESt ~ - ` ~ ~ - ~~O ^ FI~EO ~k~ R~C~R~EO ~ ~ _ ~ St.L~C~~ COtfN Y LA. . ftOG"c^ ~'.~,TRAS : - CIE~K C: ~ COURt . ~ • aCr!'FlV ;i~!1C1~,...~..~."~' yJ ~ T . ~ _ p~ ~ i t ~z AM'15 : ~ ~ ~ ~ . . . . ~ : . f° i . ~ ~ ~ ~ I TURTIICR CFRTIFY ihat 1 will regi~ter at m~ tocal addres~ vrl~en the re~istr: tion books reopen. and comply with all othcr rcquircments ot a Ic~al tcsidcn~ of t~iis Statc. j; # I FURTII •:t C}iTJT'I' Lfist 1 havc no inttniion to rciurl~ to my formcr domicilc, and l inlcnd to rcmain in a d: ~ , Counly, ..~;,~~C~LC-~ , ST . L uc ~ ~ IGty) . 't 1 " ~'lorida, pcrmancmi~ . t! ~ ` . ~ ` 7 ' ~1 : - . ,;.•~~'1 . ~ ~ . . ~ G. ~ - ' s . •C / . ~i ) .~~J f'.J<. ~ . . ' ~ . ~s:' / r ~ _ ~ '~.-i.~ ' = V ~ t ~ 1: = ~ ' .`."1-. ' f . : r- ~i- _ ~ ' - . _.~t : r, , . , .o , ; - ~ lN _ : - . r ~ . f5 • i ~ '(AdJrrss) S~~•~r~ lo ~nJ sub~~ril?ed bi~tot o mo thiy ~ d~y of ~1 . ~~C~- ~ ~ ~-t ,u a.». 7~5 - _ j ~ , ~ , ~ (,~Gl;R _!'nl7'R/~ ;,~Gt,-FR{t (3F C I(.f.Ul T COU2T ; : ~ • - _ ~ ~ i :~7. LUC~L' COUtJTY, f LOR 1.t)A ~ ~ • S ' + f)Y: ~c~-L G~~~ f.PU1Y LCltit ~ ~ . ~ ~ ao~x 242 PA~E17o0 . - • ~cnE,.,.~~~i:~~ _ , ` . • . _ . , ~ ~ }3 4 _ . . _ . Agz : ~~~r~ z.;~..?"@,.~ ; . . , . _ _ . . ~ . . 'i;.~r ~ y ~r..-~ :3 ~f-^#~~«