HomeMy WebLinkAbout1149 V(i~ild~dllVli V~ YVIIii~:11~ C111~,~1 V1~1iG~i~~7~~~M
' • ' ~ i
. ,
~
~ r
3161~4 '
i
TO THE CGERK OR THE CIIiCUIT COURT,
ST. LtJC 1 E ppU~y. ~p~~: .
This b m~? declataUoa ot Doaateile ~nd Citissasbip ia ths Sbte ot Flotida that I an ttlin~tb(s dy ia seooedaaa. and ~n
aoetorn~ty witb Seetion 222.17. Florida 8t~tutes. •
I ~r~s focme~rl ! legal resideat o[ ~ y~'r ~ I
. 1(~y?1 TlSatd
restded at ,~3- c~~3' ~ r_3 d d - Ho~rever. I bava cbanged r~? douJcile to
(8te~t ~+~d Nv~bKl .
aad aan aad iuve beea a boaa Gde resident ot the State ot Fbrida sinos ~,SE I
P~~
19 J~ and I reside at ~,1/d -7 ..SE~ir lS~r~D f~ . •
l8te~/aedNu~~r) '
~ ~ _ ST . L UC I E couucy. Florida, ~
tdq~ ~ -
snd this atatemenL h to be taken as m~? decLratlo~ of eit~enship. setwl kgal resideAOe a~d domkile in tbe State ot Florida.
IF FOR THE PURPOSE OF ENROLLING If fOR 110MESTEAD PURPOSES~
CHILDREN IN SCHOOL~ P~EASE STATE PtEASE tHECKt ~
THEIR NAMES:
~ h7i1~7 ~T S
fJ.EQ AkD
~T~{l~IE C, ~f i
ROGER P(1 ;
- CIERX ~CE3G11f C8~1'
RECOR~ YE~~FIE~~.~,..,~¦,~,:
.
- &r~ ~ 2 ~s P~i'~5'
. ~~s~4
I FUATHER CEItTIFY that I~1 register at my local eddress wliea the registration books :tApen. and comply with atl
other requirements of a legal resident ot thu Slate. -
I FURTIiEc~ CERT~
FY that I have no intCntion to retura to mp tormer domicile. uid I intead to remain in
i~/ t~ R~(' ~ , S T. L U C i E , Cvunty.
((tit~) .
Florida. permanenti; .
~ ? aC9'~~..~~~
~ie~ . s,=.~.:~d r- v~,
tN.~~
D~v~' G , ~i~n ~r-s
ceaa~...~ .
SM?a to and subscribed betore me this dsy ot
`a''"'`1 , A.D.19 ~
•
RO_ G~F~;POi TRA$,_, Cl.ERK OF C IRCUI T COURT
;J
sr~. :i:~i~Yi~~~~o~+"~,: F~oR ~.ua
. . i ''s ~ ~ ~
PT~~ xf'. / Y 1 S.
_ v\l •
r-" EPUTY LERK
~ `f 'A~~.l• ~ • ~j~G-~.
~•S~ • O~
~ r .
, T.~L a*:
o ~ 243 ~1~~9
SOOK
• ACO Fwm 71 •12
- , - ' _ _ _
,,~~..,1 _ . . -
: • -
; -
t