HomeMy WebLinkAbout0158 ~ D~claraYi~~ u~~ i~oo~nicil~ and Ci~iz~~s~i~
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~ T:~ , COVNTY. FtAitlDe:
• TAb ~s aqr dalantioa o~ Doraicite and CitizcaaNp la tb~ State ot Ftodda tba~ I am 61ias thia d~r ia ~too~daace. and in
eoato~wiy MItA Seetloa 712.1T. Flo~ida Statrt~s.
I was t m~, a iesal e+esideat ot E91 _ a/a j,,„ 1~ ~ , and i
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~uided at,S~G //e : ._~..s~P~ r~ Y,~~ How.we. I uave cuanged uy? domia'!e co
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asd aa? and ba~e beea a boaa fide resident ot the Stats ot FlorWa sines oqa da,~r ot
,19 and I restde at s~t~ -•~~•r,~ n _
1&r«t ~ad N~b~rl "
_ P,. S~ L ~ ~ ST. LUG 1 E Ca~at~. Fforida, '
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aAd tbis atatement b to be takea u r~yr dee4nUon oi eitiunslJp. aduallegal rssideaee and domicib in the Stata of F'locida. t
IF fOR tHE. PURPOSE OP ENROLLIMG I~ ~OR HOHESTEAO PURPOSES~ i
CHILOREN IN SCHOOL~ P~EASE STATE PLEASE CHECK: ~ ~
THEIR NAMESt
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- ~AM 26 ~K'~ ~
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1 F'URTHER CERTIFY thst I~n71 register ~t mr lo¢al address ~rhea the registrati~n books seopen. sad eompir witL sll
Otlll~ !lf~lllKlDeA~3 O~ i jC$lI [~lSIa~O~ O~ ~115 S~i~.
~ I CER1`IFY tl~at I have Ao intestion b return Lo m forioner doauc~e. aad I intead eo ren~ain in
~ s T L u e. . ~ ~ ~T . L u c ~ E . Councy,
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Fbrida. pesmanena;
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Sworn to and subxc'bed betore me this ~ d~y of y,~ ~ , r~ L
, A.D.19~~ 7
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ROG AS CLERK Of C IRCUI T COt~2T ~
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ST. LUGiE COUNTY, f~OR10A ~
BY: ~'S .
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E P UY Y E R K 6apx%:V/~? i kL~
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