HomeMy WebLinkAbout0338 C~~c~~r~$ia~~a ~fi l~~r~icil~ ~n~9 C~~~~~rash~ ~
~ t
~ ~ ~
. ~
9'0 TlIE CL~:ItK Or' TIIE CIRCUtT COURT, . ~
~3t1.1 E~t) ~
ST. L t1C 1 E courrr~r, ~.o~inA: ~
Thts ts my dcclaration ot Domiciic and Citizcoahip in tha Stato ot r'loridd thrt I am tiling this day in accordarce. ~nd in
conl'ormity with Scction 2~.17, Fiorida S1.atutea. :
l w~s tormorly a lcgsl rc~idcnt oi Q~,~ ~ ______r~ ``,~j~ ~ d ~n~ j
, / l (~7'1 1~alel s
residcd at ~t~,'~~L$ L,ti,S~C~, ~e t- • . I~awovcr. I hnvic ehanged my domicilc to
l•St+e~•c a„d NumDer) • ~ ~ rl
and am and havc bccn a bona tidc resident of ihe Ststc ot Flurida since _ ~ Sf day of
J
!~l A~ e~- . I9 7~- and I reside at 3 4 Y ~~a r e s r c~
(Street and Number) ~
~d r T e~T C I E'_ ST , L UG I E County, ~lorida, i
tae~)
antl lhis slatemenl is to be tnlcen ns my declaration oi citizenship. actual iegal residence and domicile in the Statc ot Florida.
IF F'OR TNE PURPOSE OF' ENROLLING IF' fOR HOMESTEIlO PURPOSES~
CHlLOREN IN SCNOOL~ PLEASE STA7E P~EAS~ CHECK: ~
TNE iR I:AHES:
4 N A ~ .L. ~ /S -
l~ e ~~r~ ~ ~.e~c~~s
- . ;
_ ,
~~iEG A~~. +:EiL'ROEO
~ aT. L:S"v1E L'~Ukir FLA
~ ~G„F ' f•~ TA~S
- C_E:.~ ~ - ~ C,.JRT
Rrrrv, ~`c>~lF~ n
• ""'r..s~
- ~ ~@ 3 so PH'76
~ ~~3v~~~
1 FURTIiER CF,RTIFY that I will rcgi.~tcr at my local sddresa wf~cn thc re~istralion i~onks reopcn, ar?d con~ply~ .vith al!
other requircments of a Ic6a1 resident of lhis State.
I FURTIIE;~ CCI2TIi'1' that I havc no inlention to rcturr~ to my l~rmcr domiciic, and I inlend tu remain in
' ~er? ~ T. .Luc' ~e $T. ~_i!C LE .Gc~unly.
ICity) _ -
Florida. pcrmancnu,-. ~
` •
, ' ~ , "•~~i ,1,, ;
~ • -
. j 'G L ^ " .
. , -i• -
. ~ . F^ ' ` . _ ~ ~t. ~F ~-G `2,~.~
. ~ ;
. -
. .
" (N~tne) ~
/ ~ (AdJrc~s) ~ ~
Sworn lo ~~nJ sub~crit,ed 1?eforc mc 1 hiY rL~. day ot ~ O~ `/p Y~.S 7 k- -1 C k' T o1"i"j,~,~,r C ~E~
A.11. 2'J__!:~
RnG~R POI TRAS,
CL~RIf 4F C. IRCUI T GOlJ~2T
ST. LUCIC COUNTY, F~OR1U/1
E3Y :
' 11T1 L'ItK
~`~i ~ A(it~P~~~.n7i
. F, :f
~
~ 3:,~'
_ _