HomeMy WebLinkAbout0376 Declaratian of Damicii~ and Citizenship
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TO T11E CI.ERK Ot' T11E CiRCU1T COURT.
ST. LUC i E ppUM'Y. i1ARIDA:
TAIs b a~y dtclaratwe ot [)omic~ ae~d Citiie~uAip iti 1M Stat~ ot F'brid~ tAst I ua Gliot tWs day le ~eewdaucs. and in
eealoraaity ~itli Sectioa ~.~T. Fiorida Statutts.
1~ru t~ a k~at residtnt ol .~iS~ h'T f i ~ C.c c'i',- i c;. ~ T-' a~d 1
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t~aidcd a1 c~ ~_h N C~c ! c c- t- I- _ Ho~rev*r.11uv~ el~ae~ed n~r daAicik to
{~fM/ Y~ N~1N) ~r
a.d a,n.nd ha~. peen. bona r~d. res+deac o( tb. siat~ o( Florid. sinc. d~l ~
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/~1 ~l C~ cl T ! L' aod 1 rtsid~ at ,,::4 , ~ `>t' . f ~
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I~t~t ~rd N~1
f~ f~,' t' ~ ST . l UG I E Co~ae~. t'brida.
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ud tt~Is statea~ent is to be takca as mr dedantjoa ot eit~ensAip, ~etua) k6a1 residenee aad domieile ia tM State ot Florida.
ii' i'OR TNE ~UR~OSE 0~ ENROLL ING IP 1'OR MOMEST[AO PURPOS[S~
CMII~REN IN SCMOOI~ PLEASE STATE ?l[ASC CHECK: ~
tMEIR NANES: .
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1 FUItTIi~:R CERTIF'Y that 1 will rrR~~ter at mr lacal addrcs~ when the re~stratioe books reopen, a~d complr with ~Q
olbcr rrquircmcnts o( a icR~l res~dent o( th~s ~tatr.
1 F1SfiTlIE::Z CEIiTIPY that 1 havc no int~~ntion to rcturn to mr fo~mcr domicik, and 1 ietcn~ W rcma~n ~o
t 1 t I E- h' ' L . S
L.~-_U_~.L~ . County.
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~ Fbrida. permanen~i, . .
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6wKi to ~n~ futntrit~cd I~r(nrc mc thi~ d~r o~ I~ ~_c~ r[ ff<. f f c
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ROGf:R P01 S,__C_,`E~tK OF C i i2CU I T COU2 T
~ ST. LuC I E COUNTY FI,OR t t~l?
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