HomeMy WebLinkAbout0064 ` _ _ . _ , . . - - ~
aeclaration o~ Domicile and Citizenship
.
, . • ~F.
• ~ ~ 2
~ ro~cc~xo~~~c~ucurroovRr. ~ `3~13~ . _ ; E .
~ ST. lUG 1 E ~p~y ~,p~~~
_ .
~ Tbi~ b a~r deelaraUos ot DaNdle snd G~t!i•asAtp ia th~ State o~ Fior~d~ th~t I am ~ tiits dy? ia sooorda~a. a~d ta
aoatvcnaitr with Seetion 222.1T. ~'lorid~ 3tatata. -
~ Y - , , aad I
I Mss t a bgal resWeat ot ~ n A '
tCl~l?1
caidod ai _ . . - Hawvrer. I baw eluaged aq? domie~e to
18~n~t ua Nw~bKl • -
sad sat aa~ave beea s booa Qde resWeat ot ths Stat~ oI F1orWs sIae~ C. Q~„ ~.._,_~dy ot
1~.~. aad I reside at ~
~ vd Namar! _ i
' ST. lUC I E ~~y,~~ ~
tav~ .
~ and thi~s statemeat is to be takta u o~r deelantion ot eitiua+hip. atna! kgal naidenee and dotnie~ ia the State ot Fiaids.
~i~ ~vi~ 7HE PURPOSE Oi ENROLLfNG - If f.OR HOMESTEA~ PURPOSES~
6NiLDREN`-IN SCN00~~ P~EASE STATE PLEASE CHE6KS ~
THEIR a~?NE's: _ ~ - - -
~ _ . , . ~~01~~~
. . - ~T~~i~ER tOKA~s „
~~eR+c c~~cwt cavar -
^`~~r'*^ YFR:FI~~
~
; - - ~ Auc ~3 9 36 AM'T1
~ 3'76~
I FURTHBR CERTIFY that I w~71 register at my tocal address rvhen the registratiaa books reopea. and comply wttb all
otlkr tequiceraents oi s kgal resident ot this State. - _ .
, j E'Y thut IJ~
ve no tnteatioa to nta~rn to m tormer domic~e, aad I intead to temaio in
~S~. ~Luc~ , ~T . Luc ~ E ,_Couaty~
-T lpt~f . .
Fbtida, peraaanenti;
.
: ~ . - .
t .c:, .
~ • ~~j , y ~
. •
~ , . = ~'t•; r
' ~ • ' -
: c_-t s ~ . ? .
' / ' C~~,~ v v i"
~ -
: n r . . . c : C " -
: c-> : = ~ . ON $oo~ I'C i~ • .
. . -j~~:~.: y , M
~ ~ ~ ~,T ~
' ~NuM~
y
- ~ lAddr~a) , -
Swora to and sub~cribed bcfore me thts day ot
, • _ .
A.D.19~y_,
R AS CL RK OF G tRCU17 COU2T
ST. LUC i E'COUNTY, f ~OR t UA _
. .
• BYs -
PUTV LERK s~
• ~ • 6~It lr~ P~I'~E . ~ .
. - .
~ ~
, ~co r•.,: r:, ; ~ r