HomeMy WebLinkAbout2221 E
Q~c~~r~tion ~f ~~~iciie and C~$a~~n~hip `f '
~ . ' ~ ' ~ ~ j
. i
, . ~
• y ~
TO TII~ CL~;RK OF Tt1E CIRCUIT COUItT. ~~~9
. ;
ST. LUC ! E ~pUN'ry~ FI,pR1DA:
Tbls is my deelarattoe o~ Domicilo and Citiseasbip in the State ot Florida that I~m C~ltns this day in aeeord~neo. and in _
toatormity with SectIoo 2~.17. Fiorida Statutes. '
.
, . •
I waa torm~c~ a kgal resklcat of _ m~~Bl~/~'`E~~ ~ Dh~/ D ~ I ~
lCit71 lSt~te)
residcd at / ~S/ARSlY iQ~ Iiowovcr. I h~ve cbangcd my domicilo to
lstn~t ~nd Nvo4bK) •
and un ~nd have bcea ~ bona fidc rc~idcnt ot the Sti?to ot Fbrida sincs ~ Sr day oi
S!" P T. ,,19 7 s. and I reside at ~ S 0 ~vE SA~ /~A . -
(&r~t sad Ninab~r)
Pe QT S T 1..: uc : E ST . LtIC t E County. Flor~d~.
tCV1
and this statemenl is to be taken as my declaration oi citizcnship. aetual kgal restdence and domicjle in tbe Stato ot Flwids.
~P F4R THE PURPOSE OF ENROLLING IP POR HONfStEAO PURPOSE5~
CHILbREN IN SCNOOI~ PLEASE STATE ~PLEIISE CHECKS ~
.THEIR NAMESt .
7~f/o/yt~9s P LJ/9~.[~.v6 • ~ -
- ~
_ •3
1 FURTHER CERTIFY lha~ J will regi~tcr al my loca! address whcn the registration books reopen. and comply .vith all
othcr requirements o[ a Icgal resident of ihis Statc. ~
; I FURTI~E;t CERTII~'Y that I have no intEntion ta return to my (armer domicilc. and I intcnd to remain iu
i '/o~cl S?• G.vc ~F_ ST. LUCI.E ,Cuunty.
iCitr) .
~ Florida. permanenti~.
~ ~
~
E ~ •
~.~~Yi
:..t:
_i _
~
.~i,,r' \J _ : S~ ,~I .j ~ . ~ ~ .
/
~ Q~V •~~~j~'~L~'~I/
. ~lti~ a ..w ~ -
~ ,J c•, ~ %
i ~
~ ~CG • ? ~~1~~L~~'~/i
; ~ : ~
_
- ~ v s'+. ~ ~ ~ : _ .
s' *
_ . ~ ; -
~ ' <~7 L.h'~ • ~ _ r- •
~1 ~ - ~i : / L~ eC`Lt ~ ~ ~ , '~-l.L'?1
. 4~:~J~-_,~t'~
• v
~ . k ~ ~ (H.,ue~
~ ~~l v ~
; C~g CO - Z NE ~l~.r~~ ciR~
; ~•...f..~,•.,~•'` lAdJress)
~
~ Sworn to euJ suhccril,ed Ix+furo mo thiy dey o( Pp ~ r S%. Lvc
~
~ ' L ~
; .~.n.~~_~
~
~ f1lFQ AKD R~COR Ep
~ R~c=r•_R NO hs,~ GLfRK OF C I RCU 1 T COU2T _ sT ~~~~E couMTtr
ROCE~ ~
~ ST. LUC I L' COUNTY~ f L.OR ~ UA RE ~pEp F~~iTRAa '
~ cauRt ~,,~c.
~ -~-~rr. ~ \
.
~ [~Ys rn~mc AUtI 1+1 1120 ~ ~15 ~
t EPUTY LCftK ~
~
s
~ . .~14~89
~ oa
E
~ . ~ ~f " AG[l F~n ~u'11 n;•
~
~
'f".~;- ~ _ - -
z
~ _ ~,y~ .
~ •z ~
~
. . .