HomeMy WebLinkAbout0178 . _
_ _ . _ . . . - -
' aeclaration of Domicile and Citizens~ip
. . ~ y
. ~ ~~rs ;
. - - - ;
,
TO THE CLEAK OR THE CIACUtT OOURT. . ~
'
ST. lt1G I E CovNTx. ~'tARto~ ~
.
. . l :
• T6b b m~r d~elasitbn ot D~r.:Wk aad Citi:e~hip 1a tM Stet~ oI Fl~ida tbat I un t~ tbts d+q? ia aooordu~a. and !a ~
eoato~aaity rrita Seetioa 222.1t. Florida Statuta. .
I ~r~s f
~ a k=sl re~Weat ot _ L~'~~•~ _ ~ - sad I .
. ~t~r? l~t•i
e~sid~d at ~ Norwes. I lW?w eban~ed ayr dank~le to
t~••eN.se.e1 .
ud ~m aAd have beea a boa~ Gde resideac ottAe Stataott7o~ida siaa d d~y ot
19.z,~. aad I ~esW~ at ~ ~ard.
. . .
~Ba.K ¦d N..ewl
_~o~ ..~,~vc ie , ST. LUG 1 E Couay. ~7o~a.,
taa~ -
' wd this statemaat ts to be takea u apr .deelaratia? ot dUunahtp. ~etwt kgat resideAee aad domicife in tbe State oi FZo~ida.
If POR THE AlIRPOSE OF ~NROL~iNG Ii POR MOMESTEIIC PVRPOSES~
CHitOREN IN SCN001~ P~EASE STA~E . PLEASE CHECK:
tMElR NAMESS - - ~ ~
_ ,~~.~L ~ _
.
,
- sT.~u~E
~arn~urs~
CLEIIK GIRCUIT COIIRT
~ p-~~an vERt?~EO
- ~ ~ A~c 23 2~ 3 PN'11
. 3'7f,~
I FURTHER CEIiTIFY thst I will register at m~r local sddresa +vhea tl~e rcgistratioa 6ooks reopen. and eomply with .all
othec reqninmeacs of a tegal tesident ot thb State. '
_ t_
- €
I F[~'RTHE3 CEBTIFY tlu~t I have ao intention to retnrn to ml? foemer dae~'le. srid I~utend to . remain in
• ~ T. U C 1 E ~ County.
, .
T'~{Of'ldi~ p@liAMED[~j. -
_ ef ~ - ~ ~ ~
,.s~~b~~~.,..., .
.''~~~1T' C~;'•• -
C, ,
~ Cr _
~ ••\j;1. A .~~i •
'C.l;•g~ ..;'-~=jC~: J? -
t• ~ : .
-{«~r.- : ` ~ - r
j '.f'~"°Y:• I . .
. G : ~
_ ~ ~;;-:~1 Fi; s .
. C`~ : . s 3~ - ~ 'Ct ~ _ ~ ~-i
.,••Z ~ : i ~ ~ i. ~ ' .
~e. ..'J~... _r ~ ` _
~ . ti . L~ A
i~{ • ~~~..~Fi~~'~~ •~1 ~~~i~-~=.. ~.~r~~'i~+~.ri.Y~~_
U~ , ee . . _ .
, ~ E - -
•-'r~r~~ts+.+ .
- ~zz S
Y. ,
Sworn to aad aubscribed belore ms thls ~ dy? of
. .
A.D.19~.., ~
~20G,~,R PQ~TRAS, CLERK Of C IRCUf T COl~2T
ST. LUC i E COUNTY, FI.OR 1 oA •
. BY: ~
~PUtY IERK .
. . .
~ _ .
~
~ 600tI J PACE -
~cn fiQfm,~ ~ -