HomeMy WebLinkAbout0157 t~ecfa4•~$i~~ c~f I~a~ici~ • nd Gi~~z n~~i i
~ s p
~ ~
. 1
;
. 3463t),, ~ ~
. . `
TO TIIF CI.ERK OF TllE CIItCU1T COUItT~ !
ST. L.UC I E CpUNTY. FLOItIDA:
0
Thta b mr declaration ot DomIcile and Citi:en~hip in the State ot f'iorida tha! I am Cding thL dar in accordance. and in
coatormity with Section 2~.17. Florida Statutes. ~
T wu tormerly a kgal resident ot C A~.I A~ ~ (_J h~~ ~ I
~ ~ r1 t8eaa) .
resided at ~ ~ - ftowevcr, I have ehanged mr domicik to
(Stn~? ~nd N 1 •
and ua and have been a bona fide resident ot the State ot Florida aiacs ~ dar ot
1 ~ ~ 1
,
-_uS~iti ,19~ tad I reside at ~ 2- ~ ~ ~ ~ C-- ~ ~ ~ ~ ~ .
(St~wt aad Num 1
_ . ~ ~ C~C-
: ST . l UC 1 E Couat~. Fbrida, -
tac~)
and this statement i~ to be taken as my declarition of citiz~ruhip. actual legal rosidenee and domicile in the State ot Florida.
- If FOR THE PURPOSE OF ENROLLING IF FOR NONESTEAO PURPOSES~
CHILDREN IN SCHOOI~ Pl.EASE STA~E P~EASE CHECKS
THEIR NAMES:
~
~l ' 7 `
i .
~ A~ ~1 Y ~ ~ ~ ~~.~1
~
~ F~~~o Ah?~ ~~cca~oEo
, ST. LUCtC ~OU!!TT F~A,
ROGE? r'OiT~7AS
Clfk~ Gf~Z~U1T COURT ~
RFC:)?- lr-~r1ED
- Sfr 1~ 9 4z AM'76
34631pg
I FLJRT}iER CERTIFY thaL I will regi~ter at my local address when the registration books reopen. and comply wilh all
other rcquirements of a Icgal resident o[ this State.
I F~iT~I1~;Z RTIFY that I havc no intrntion to rclurn to my former domiciie. and I intcnd to remain in
~l- S T. L U C f E , Cou nty.
IGtr) .
Florida. permanen~i~ . ~
l
4
i '
i •
.~•~'.C•'~~ ~ i
i ' ~
i . . ,i3 ~ .
?
. .
- - .
. .
. IName)
l
(Addre
~ ~
Sworn to a subscribed b~toro me lhis dAy of ~
~ , ~.D. ~4 76 3~~s c7 -
ROGER POI TRAS. Ct_ERK UF G IRCU1 T CGUF2T
~ S7. LUCIE COUNTY, F~ORIUA •
BY:
- :rurY ~enK .
. ~ ~V~
6L~r F~6E ~