HomeMy WebLinkAbout0048 • . : . . ~
D~~fara~~~n c~f Da~r~~c~i+e ar~~ C~~:~~ns~~p
_ t~3~~`~ ' [
To T~ie cc.~~t~; a~~ TH~: ciKC;ur~ ~vr.:.
ST. L UG 1 E GOUtv'rY. ~wtuD~: ~ .
This,is my decluetioa of Domtc!!e :nd CIllst:nsbi~ ia the State oI Ftorida tlut I sm GWrg this dn~r ia aoeordaace. and in
contormicy wi~h Seccea, ~a7. Flor~la Sca~utes.
, .
~ I was former a kg~l resideat of ' and I .
, ((~7) tStatal
resided a1 Howcvcr, I have ehau~ed my domecile to
! ard Namb~t) ~
and am aad have bcea a ba~a Cde resideat ot the State of F'~orjda sinee ~ day ot
!.19~, aad I resid~ ~t ~G~Sk' d ~ '"~~-«-!l~ -
. (8teMt +ad Nuu?b~rl
j- ST. LUG 1 E ~,,,,cy. ~h
~~t .
and tbis statemeat is to be takee u mr ckcluntion ot citisenship. actual l~egal residence aad domic~e ia the Stata of Ftecida.
~ ~ i'~i~c =tiE ~L'~°A~E ~!f E~lRQ!.! !~G ~ ~ ~dit i10KESTEJEO Pt1RPOSES~
-CNtLOREN i:+t 5CNt30L~ PLEAS~ S~A4C P~,E~iSE Gt#€6K: ~
~THEIR NAMES: . -
' . -
" e~~~,~(3t7.
j
fllfd a?•: ~E~VrtLED
ST. tU~~r ~HTY F~A,
. RCC:'~ ~ ; -,e$ t)v" _
CIr=R % ;?t-:.L~l:RT~,~}~
. G ~F: . ~ f r """r-=F'~=
y 3 04 PH '70
I FllR1'fiER CERTffY that 1 will register at my loci! address when t1Se registration books reopen, and compiy with all
other requirements oi a legal resi~feut oi this State. -
I i~'URTI~E~ Cr.~T th;t I have aa intHntion to return to my foraier doau~ile. ans~ j intend to remain in
'~~'t~" t~~t.P_.~..,~ e $T . L U C E E ,~n~y _
.
. ~~y~
FMrida. pcrmanenti; . ~
i ~
~ / _
? ' - .
` 1 ~ " ~ V ~ ` L~ a~e~~/i
(A ~reas~ -
i
Sv;arn to and subscribed~bc(orc me this day of ~~/'~t~~t_,P T, r,~~_
, ~ t; .
~ . A.U. i~ 76
ROGE~: PO! -i't~AS, r~ ERK OF C IRGUI T COU2T
ST. L t1C I E COUNTY, F ~OR t U!~
BY: ~L~--
' EPl1TY ~ NK PP~ ~S I'A~ 4~
,4(f!) F'o*m i! ~
~ ~n. .c 1">.~. . - r-' '
~ . . ~..7' ''-e~.fF+`f"~~