HomeMy WebLinkAbout0242 ' Deciaration of Domicile and Citizenship y'
~ Tor~c~~oFrH~c~ncurrcov~err. 3f8Q~q ~ :
sT. ~uC ~ E oovrrr~r. ~.oRm~ ~
~ TAL~ b a+y d~eluation ot Dom~eils and Ctti~o~~ship ta tM Stau ~ Fbcida tbat I am t~ tbis da,~r ta aocoidaae~. and tn
~oato~eaitr wttb s«cioa r12.1T. F'lor;a. sacut~. ~
/ /
i aas ~ s k~al raideat at ~ A ur ~ ~ e.J w~ sad i
1CM11 Id~.e~l
raid~d at '?Y Os ~'1~ - Ho~wt. I baw ebsaaed eu~? doenicile to ,
l~ ~d N~1 ~ ~
aod am and hsv~ beea a boaa Gd~ r~sident o~ the Stat~ ot Fbrid~ siae~ ~ ~7 ~ ;
i~~.~ai~a.u ox~~0 ~~;~Jc c~~4 ~r~e y~G~ ~ ;
~ t~trNt ad N~~O~cl `
~ r. v CI c ST. LUG 1 E Couacr. Ftocida.
1CIe~1 " `
' and tAts statemeat b to be tak~u as m~r deelaratioa ot dtisewhip. aetual iegal resideaoe aod domie~e in tAe State oI Florida. ;
• ;
If iOR THE PURPOSE OF ENRO~LING Ii fOR MOMESTEA~ PUR~OSES~ ±
CNII~REN IN SCH00~~ PI.EASE STATE '~EASE CHECK: ~
THEIR NAMESS
~T. ~YOIIL C01{NT11R f lA.
CLER~ CIRCUIT COURt
~tr Y~'PIFiED~,.._
. Jn~ 1 II 24 AH'iT ±
3b'8~69 :
,
~I 1 F'tJEiTHEA CERTIFY that I w~! rrgister :t ~aY loa~! ~dress when tba tegisintioa boolcs reopea. aad compir w~ith all
~ other requireraents ot a kga! resideat of tlus Stata. _
I I~t1~ E~ CE F'Y hit I ba~e no intrntion to retura to m former domicik. apd I intead to remain In
6, `~o.-~ ci c- _~T . L u c ~ E . Ca~nty.
~a~>> . .
Florids. pera~anenc~~ .
ME ~ Mr~
S Z~ ~~i
- ~ M~N s- :
~ .
~ ?
~ - - - ~ s~yy_- ~ -
~ ~~~I~~~~~i~~~~ ~~~~//~"L ~ ~ I
. • . ' ' ^ . I, / ~ 4
~ ~~f~ P~,v~ y ~d,~~ _
~ . _ ~ _ - ~ ~ 3 ~1~~"j-:
5~vora to a sub~e~i~dbefore me thi~ day of d r! J G[ Or~
~ , , ~ ;
P ~ +l ~ ~ A.D.19L?~ `
C ~ ~ ~
R f. AS C RK OF C IRGUI T COU2T
ST. LUGIE COUNTY, FLORtUA ~ `
. x
Bv: - . ~
_ E P U T Y l E R K BOUK ~Vt7 PACE
. . . .
. •
, IlGO Form ii 22 •
_