HomeMy WebLinkAbout0977 . : .
. t~~ci~rat~~n o# ~~m~c~le ~nd Crt~~~nship
~ ~ ~ - . .
. . .
, .
TO THE C[.~;RK OF THE CIItCU1T COURT, . 3~3~y9 ,
ST = L UC I E , ~pu~r~ fLpRIbA:
Tbb ta m]r docl~?ratlon ot Domk~e ~?nd-Citizctuhip ~n 11w St~to ot Ftorida lluit I am f~In~ this da,p in ~ceordsnco, anti iA _
eoafocmiLy wilh Scction 222.17. Florid~ SiatuU:s. ' ~
4~~dC~ ~ , .
I wa; t rm~~l a Iega1 residcot of - ~ ' aad 1
. lt~ityl Stato)
r~atdcd at • l~owever. J heve changed my domicilc to
f8te~at ~d t~ua?Ow1 ~ •
l~ ~
aad un ~nd have bcea a bona fidc resident ot the Stnto ot Fbrida since d~r oi
]9_.~.. and I resida at Y.-Q~~C1(,C.,
t iSuwt aed N+mb~?) -
_ ~ ~ ST. LUG I E Co~,,,ty. Ffo~ia.. .
~ . ta~~l - .
And ihts statement is to be takea us my decluatJoA of citiunahip. sctual legal.residence ~nd domieile in tbe Stat~ oi florida. "
IF POR TNE PURPOSE Of EHROILiNG IP FOR HOHESTE/10 PURPOSE~~
CNIIOREN IN SCHOOL~ PLEASE STATE PLE/1SE CHECKt ,
THEIR N11MES:
. F I.ED ~OUN?V ~
~ s~~ ROCER ¢01Tit1?5
C1.ER
~ERkf EO C~~
. RECORO . 3 ~ ~~C_ "
- . _ ~ ~ 1~ 1 °
. . ~~99
.
i I FURT}IER CF:JtTIFY that I wiil rcgi.~ter at my local address when the registration books reopen. and compip with all
' othcr requiremenis oi a legal resident of this State. ~
i
~ 1 E'URT}IE;t CERTIFY lhat I havc no intention ta rcturn to my formcr domicilc. and 1 inlcnd to rcmain in
~ ST . L U C 1 E , Counly.
i tGl~1 .
€ .
t'lorida, permancnt;; . , ~
•
t
- ~ , 1
' .
J! ~'f
.c " ~ . • ~
t ~ •'.y~
JtJ ~ { 0 .G
: • ,;4~ :a"~ j
~
;Gp'~ ~t' (N~une
~ •W~~::~~.~•i~G.~~~. ~ T
~ ~n - - c~ : = s.: . t
~ ~.:x~~ :`t.E'~ C: G ~~Y / ~ Jf d + I I~Mi~)
Sworn to a~~ +l~rq t~ lfii.9 day ot • vr
~ " ~'.:,Y~~r Y!;,.'• ~`w.; • ~ /7~
, . ~
, ~ . r ~ ~v : , • aC..~ ~~~~N ~"V ~S / j
. • '
~ - t I ~
ROGrR P01~~'i~2A
~„~~CLF:RK OF C IRCUI T COUZT ~
~ . i
!
ST. LUG 1 E: COUNTY, F LOt21 UA ;
fsY: . ~ ~ ~
f.PUTY 1.CltK ~ ~ Q;~~ ~b~ ~ F
, ,
;
.
' • ~~:n ~ . . .
v ~ -
.m ~ . ~ ~ _ . - . ~
~~-~W~`~-~, _