HomeMy WebLinkAbout2957 ~
. . ~ ~ `
~ 3193~?~?
~ De~tara~E~n ~f Q~~nic~le a~d Cit~z~~s~iip ~
. .
Tp 111E CI.EItf: OF 17IE CI RCUIT OOiTIiT. ' ~
ST. Lt1C t E ~~rr~r, ~R~n~:
TAIs !a my dccla~~tion ot Clomin7e and Citiuaship la tbe State ot Flarida tlut I am 51ins thu ds~ io aceadancc. and ia
toafotmit> >rith Scclion Z22.17. f7orida Statutea.
I wu torme~~l a k~al resideat ot . ~ t '
_ ~ yl {StatN
mided ~l ' floxeeer. I 6ave chan~c
d mp doeninle ta
lSteeet ud Nss0atl • , y .
aad aon and have becn ~ bona fide residcnt of t6e State ot Florids since ~ day of
19 - and I reside al e
{Slr..t..at~meerl •
.~7~• lp.r.~'-~ . sr. ~uc ~ e ~c,. ~ria..
' taVl
and ihis statcment is to bc takcn u my dodaration o[ atizenship. aetual k~al raudeucc aad domia'le in the State oi Flo~ida.
- IF FOA THE PURPOSE OF ENROILINC I~ fOR HONESTEAO PURPOSES~
CHIIDREN IH SCHOOI~ PLEIISE STA7E PI.EASE CIIECKt I-,~ ~
7NElR NANES: ~ r ~
• ~ d
_ ~ r ~~~y)(~(~
a
~
I FUR'fIIER CEltTIFY that I.vill register at mp local address ~nc~o the se~i.drstion books reopen, and campip with all
-other requiremenls ot~a kgal resideot oi thes State.
I FUR771E:t CF.ItT1FY that 1 have ao intrntion to rMurn to a~y forn?c~ domicile, and 1 iutend w remain in
• ST _ L u e ~ c Co„Qer.
(CitJ) .
Florida~ pcrcnanca~i; . '
~
•
' ~
~ ' ~.~-~~P~~
. u?aaR,.,
- Sworn to and subxriLcd before rr~e lA~s day of
f . A.n. l9 7~
~ RO(',ER P01~12/1S. CIERK OF GIRCUI COt~tT ~
. F~CEO ah~ ~CC~R EO
~ ST. L11GlE COUNTY, FlOf21UA . ST. ~~~;i Co~i~jY ~LA.
\ :;•;?~.i~r~:u~ RE t~ErO~;C`~~WTC URT
Cet~•~•~!~ ~~~,-.1 EP Y LL'uK r'fp:f E~+~...~
` J~v!~&'''~J' =:''=~~j . ~ : ~ Oct 1t 40 aH , .
~ T5.
. J ; t-- ~ , o ~ ~ i
~°X .
v
~
; :K„~.:,~ ~ . ~ : ~i ~ ~ A(al Fww 9! i2
- ~ 2.,,~' ~ 3 . y~3'~'
~ siv
:7 1-~ : - •i:
;J~'~`t'~~.~~fa
, cs~/3'•~~:.: ..•~i.
~ ~S 0 R
. so~2~44 ~2957
. j
. ~ . , _ . Y
. _ W~~;:;~,