HomeMy WebLinkAbout0205 Q~c~~r~~ior~ ~ ~g ~amici~e ar~d C~ti~~n hi
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TO THE Cl.~ttK OF THE CI IiCUIT OQUIiT. ~ i3~~ y ,
___ST. Ll1C I E __,.,_,t~0UN1'r. ~otsmA: . . ,
Tbh b m,~? deelar~iton ot Doo~k~e ~d Citiscnship ia tbe State aI FbsW~ tbuf I am pins tl~is d~,y fu ~ooorJaace. and i~s _
caatoemtty witb Seciiou 22a.17~ I~'br1d~? Slatutes.
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t w.s ~r~ . ka.t cesideoc ot 1! 9~r, / ~ ~ '
n~ A ~k.. I ~;h`.~e- !~l?I tStasd
~wea a~ c .,.~-c~t ~ Howeves, I luve ehsnaed mx doania'le to -
- ~`iatr..e..d t~.e.d ~ t.. •
ioa aa~ and havo been i boAa r~de restacnc ot che $ate ot F`~orida staos ~ 1 da~r ot
4-+~ .r.18..~.~ aad I reside st s~ ~J ~a. Gfisu~( a..
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c~ countr. ~'forid..
and this statement is to bo taicen ~u a~r dectiratioa oi dtfzeaship, aetual kgal r~tdeaoe ~d domict~e in the~State ot Florids.
IF FOR THE PtlRPOSE OP EHROLLING . IF POR HOf1ESTEAQ PURPOSES~~
CHIIOREN IN SCNOOL~ PL~I1S6 S?:AYE PLEIISE CHECK: °
tHE 1 R NAMES: i
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" FIIEQ ~?x0 ~tECQR
. ST. ti1CtC COtlNI'r
- CIERRCCI~~~IT COItRt
- RFCORD YERtFtfO~
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1 FURT}IER CERTIFY that 1 will regi.ctcr at my bcal address when thc registntion books reopen, and corr.ply with aU
other requirements o[ a lcgal resident ~t this State. ~ -
I~R • Z CE IFY~ thai I have no intention ; ta return to my former domicile. and 1 intcnd to remain in
t'~ ,s~ ~ 3! ~•,r t~__ ST . L u c.~ E , c,~?upcr.
1cc~r1 . j ! .
Fbcids. permanen~i;. " : . .
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Swoi~n~la~~~~y,ub~erit?cd betoro me thi~ de?y oi _ ~~G- 33
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R(?CER POI TRAS. GL.ERK bF C IFCUI T COU?T ' ~
ST. LIJG I E COUNTY, F~OR 1 - ' _
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CPUTY LERK , -
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