HomeMy WebLinkAbout0761
~
,
•
~ D~~Raraf~~~~ ~~~ici~~ and C~~i~~~ship
.
~ ~ro~ c~uc oF~ cnccurrcocrnr. 35440~ . ~
~
ST. l UC 1 E ~pt1NrY. F~.ottlDA: _ ~
~
, . , . t
7bb b mp deelantba ot Domic~e snd t~ti~cnsbip in the St~te ot Flo~da ebat I sm fifi~ t1~is d+Ur ia uoordunos. aad in
_
co~a,tamky with Section 222.1T. ~'b~ida Stat~. .
T was erl a le~at e+eaideat ot "`~i~•~-~'~ ~ ,_;7~~r~. ~ T . ,
IGVI tS~w1 -
resided st ~ 3~//~ - Ho.rov~r. I bare ehaA~ed m~r domiin'le to
{~e~ta~ilrw~OKl • ' "
aod un and liave bcea ~ boaa l~de.resident ot t!~ State ot ~'laida siae~ 7~ ,/'9 d~,~ ot ~
`~j~~'~ • .19..~. and I re~de at ~ /°,~su.~ '
_ ~..e.oaN..e.~l ~
, .v~.~ P.~tG~.G ~ ST. LUG I E Coaoty. Florida.
laVl _ ~ ~
and this atatemeot is to be takea as eay deelaratioa ot dtiuasliip. actual kgal resideaee and donnidle ia t1~e State ot Florida.
If fOR THE PURPOSE Of ENROILING If POR HONESTEAC PURP SES~
CHILOREN~IN SCHOOL~ PlEA3E STATE PLEASE CHECK:
THEIR NAMES.
. ~ . -
~ -
, .
i ' . _
I - - 7 9 AM'11
j ~.EO ~MO RECOROEo
~ t iE couNtr.fu.
~ ~ ~E~ P01Til 0 ~T ~
~ . RD Yf RIFIEO T C ~ f
. . R[CO ~
l
- 3s~o8 _
~
;
_ .
1 FURTHIIt CERTIFY that I Mn'!1 register st mr local ~ddr+asa wbea tLe registratioa book~ reopen, and complp ~vith all
~ otber requirern~nb of a kgal ttisident of this State. .
~ I C tbat I havg n9, intcation to rcturn to mr former domicile. aad I iatend b nauia ia
~ ~i _~Iz ~ , ST . L U C 1 E ~ . County.
- I~t7) . .
i
` ~'lo~ida. permanencl;. _ .
~
~ -
~ ,,4e, .
~ _.~~~.~:..n...."~~~~;`.:~
~;`,J,+~~.:? . ~
'y ' ••r ~r 1
j - ',t`r~~.' ' V Y'r v~ `T~QMMOYlG~
~ • - , s~ ; ~
• = ~
: .
: - ~
, ' ~ -s`~ ~
, - ,
. r ~ ,'~Q ~
' i '~s;. .•~;~4~.r
{ . f~ a-% °'s
~ ~ ~-,s~• !N~)
••,,,t~ ..z=,-~ ~ ~~~1/ _ - 3siJ~
~:t.
~~aa,...t
Sworn to and subscribcd be[ore me tbls ~ dap ot ~ ~
~ .
A.D.19 ~ -7 ~
ER AS CLERK OF CIRCUIT CQI~T
ST. LUG t E COUNTY, f i.OR 1 DA • . `
BY s ~ - `
. P r Y ~ E R K _ d0o c 2~ ~~~E 7~,
; • -