HomeMy WebLinkAbout2715 . . ~ • • • ~
QECR~ra~~~n of lDamic~l~ and Cit~~~nsh~p ~
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Tp TNE CL~RK OF THE CiRCUIT COUIiT. .
~ ST. ll1C I E c7oUNTY. Ft.OBtOA: . .
Tbb ts ~uy deelanlioa of Domkib ~ad Citizonship ia ths State ot f'Iwid~ tlu~t I ana tiliaa this dyr in ~eeordaeco. and ~
contara~ity wilh Secttoa Y22.17, Florida Statutes. - ' ~
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1 was t~ ~ k~a! seaidcnt ot snd I
. ICtV! tStat~)
resided at ~~owevor. I havc cbang~d my domecilo to
ISteNt ~ed Nn~DK) • •
aad am aod have bcea a liona C~de t~sidcat oitbe Siuto of Florida since day ot
~9_____, aad I reside at /p?°2 / G~yC~mc~ ~v~C~. -
~ - ST l t1G i E~ ~ N~~~
cn.~.~ [ _~~..c~ _ • County. Fforida,
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and tbis slatemenl 'u to be takon as mr declaration oi citisens6ip, actual legal residence and domicile ia ihe Stato of Florida.
If FOR THE PURPOSE OF EHROI.LiNG . IF FOR HONESTEAD PURPOSES~
C1i1lOREN iN SCHOOL~ P~EASE STATE PI.EASE CHECKt ~
tHE1R NAMES:
~~~L{ICtI CDIlM~1~iLii,
ROC{~ ~~tTR~f .
- ~RER1~ ;,+?CUtT CDURt
p~~9RD.YEa~f ~Ep `~C
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I FURT}IER CERTIFY fha~ 1 wip rcgi~ter al my local addresa when the registralian books reopen. and co~rply with ail ~
othcr requircmenls of a lcga) residcnt of this Stalc. -
I RTIIE;t C~RTIFY that 1 havc no intcntion to return to my formcr domicile. and 1 intend to remain in
~c~~" PLL~-cr ~ $T . L U C 1 E . Gc.unly.
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j Florida. pesmancnti; .
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~ Sworn to AnJ sube~riLcd hetora me thi9 dny of [ 1~+~..
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~ ROC,fR i'01 T AS, CL.ERK OF C I RC U I T COUtT
ST. LUG I E: COUNTY, FL.OR 1.UA
~ BY: , .
~ UTY LEt~K
~ ' ° k ~4~ P~~~2717
~ BOOK
. , ~ ' AG(1 Fnnn 11
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