HomeMy WebLinkAbout0653 _ .R .
• D~ciaraYi~~ ~Y ~~micil~ and Ci~iz~~shi~
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TO TNE CI.~AK OF THE CIRCUIT COVRT.
ST. lUG I E OOtlrrr~r. F[ARmA:
T!?b b mr deetuatbn ot Domieilo at~d Citiscn~hip ia the Stato oI Florida tlu~t I am tillna this dqr ta ~ceordance. aod in
~oatoraaity Mith Seetsou 2?2.17. I~'lorida Statute~.
I w~s t orl a k~al reaideat ot ~~,e/2 C F S TE~f ~ ,/Z%~~/~.~ .S • and I .
IClyl l8tatd
e+estdea ac _ .~rrw/ ,~v~ . - No+.ever. i Aa~e ehapged mr doraidle ~o
18v+~t a~d Nrs~1
~ aAI iDd AtYO bEQi! t~~ i'!!~!'Dt Ot ul! ~S1iLQ OI FIOf'Ida 3i11tO S IE/~ T / ~ir 0~
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l~/~/t C' ~ ST. Lt1G 1~••aN,~eK~
County. I~'bria.,
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iDd ~II3 i~ttIDCA~ IS t0 ~iIICO i1 Q1~ dlCliTitI011 O~ CIUZ!!1l~IIp. aetual kgai nsidcnee ud domicile ia the State of Fbrida.
If FOR THE PURPOSE Of ENROLLING IP FOR NONESTE 0 PURPOSES~
CHII~REN IM SCHOOI.~ P~EASE STATE PLEASE CHECKS ~
TIIE tR NAMES:
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E COUNT1f~t~A. a
IIOCE~ F~3TRAS
dfRO YtR
FIEO C~RT v
RE
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I FUEiTNER CERTIFY tbat I wili ngister at my loca! address when the registration books reopen. and eomplr with aU
i otber requirements o( a kgal resident ot this State.
i 1 CERTIFY t~ I have ao inteation to return to my lornxr domiG7e. and I intead to renuin in
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Fbrida. perananeati;.
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SwaM subsir~td~~bctorr me thls day ot _ T . . J+3 ~S~O
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~ R9GER P01 TRAS,L C~.ERK OF C IRCUI T COt~T
ST. LUGIE COUNTY, FLORIOA •
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~ \ EPU LERK
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