HomeMy WebLinkAbout0154 ~ _ _ . ~
' ~~c~~r~tidra r~~ D~~~~~il~ ~~~r~ Gi~c~~~~shi - i
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TO TiiE Ci.~RK OF THE CfitCU1T COURT. .
ST. ll1C 1 E ~p~yzY. fij,pRlnAt
• Tbb b my declacation o[ Domicile ~ud Citlzcn~l?tp ie the State ot Florid~ that I am GIIna thi~ d~?p ia acto~dane~+, ~~d in
contoranity N ith Sectton '~^.17. Flo~id~ St~tuto~.
I was tor~ a kgal tcsident ot 6~{ C7Q 1/ ~L. ~ k'^ N' ` ~nd i .
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(Ck~rl IS~at~l
resided at ~~G ~o ~ l_' iC A~R R' ~ t/!~ ~ Hoxeree. I hava eAanged my domicile to
l8uwt u~d Nrm~~/ - •
and ~m and have been a bona Gda ~e~ident of tha State ot Florida aince Tv ~,Y G~ 76 ~r o~
BL.vn.k/ S'P~}ivis.y .4t~CE s .
.19 ,1~ . and I re~Ide at 3 M~•
R7r .S' T IC vC/.E= ST. l. UC 1 Estis~e,adN~mberl
County. Florida,
IC~V)
~ aad this statement ia to bo taken a.~ my dee4eatiuo ot eitiunshfp. actuat lcgal teaidenee sad domicile in tRe Sta~tc of Ftorida.
IF FOR THE PURPOSE OF ENROLLING I~' FOR HOHEStE/1D PURPOSES~
CHI~OREN {N SCHOOL~ PI.EASE STATE PLEASE CHEGK: ~
THEIR NANES:
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F~s I7 '9 0~ . .
35'789lg
I FURTNEIL CERTIFY that I v?ti11 register at my local addrrsa v?heo the rrgistratioe? boo~cs i-eopen. and eomplr with al!
other requirements ot A Iegal resident ot this State. -
I FU,~T}iE:t CERTIE'Y that I h~vc no intentian to return to n~y former domicilc. and I Qntcnd to remain ia
/~RT S7: t,vCIL: ~ ST. ~UC i E Couaty.
tc~:r~ . .
Florida. permancnci; .
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Sworn to aad sub~crihcd bctorc mo th;s ' d~y o~
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R.~'-''~ER PvI~RAS,~CL~RIt OF C IRCU{ T-COt~2T - ~
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ST. Lt1G t E COUNTY, f LOit t OA ~ . ~
BY: l3 , - ;
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. ePUr ~~ERK
. F~i~ ~ PA(~ ~
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