HomeMy WebLinkAbout0387 w ~ ~
i~. ~ -o i- ~ ~r'"t~~'`~5~' ' V~Lt.k.~:l~J~~~~~
. E.il:~~~~c,~~.~~::,~ 4..'v~ vbt~...- ~
TO THE CLERK OF TNE CIBCUIT COURT, ~414~
ST. L UG i E CpUNTy~ FLORIDA: .
• Thi~ Is my decla~ation o[ Domicile and Citisenship in the Stato oI Florida that I am fiL'ng this day in accordenca. ~nd in
eontormity with Sectio~ 222.17, Florida Statute~.
. I~ru tormerl a legal re~ident ot ~t°- ~3' e - a"d I -
{ptyl lsu )
resided at F Ho~rover. I have ehanged my domicile to ~
(3tn~t aod NumDer)
and un and have been a bona Ctdc re~ideat oi the State ot Flotida siace l day ot
D ~.~r~sE ~ , ~ ~ o „ r ;
19 - aad I reside at N l r ~~1LL~ ~
. (Str~.t asd NumEer)
J` f/ j-~? _ .ST . lUC 1 E Couotr. Florida,
cc~,f
and this statement is to be taken u my decLcatioo o[ citizenship, actual legal nsidenee and dovticil~ in the State of Floride.
IF fOR THE PUR~~SE OF ENROLLING IP fOR HOHESTEAO PURP_OSES
GHIL~REN iN SCHOOL~ PLEASE STATE PLEASE CHECK; ~ :
T N E 1 R N A M E S:
~ ,
- fILEO A~tO ~fGOR0E6 ~~L `
~ ST.L~IC~E C4ttKTr f~a ua~`
RL+~ER POItP,~S :
. : ar L'uC~J1T CO!~~T
. . -c -~t~
~ ~ ~ J~N ! 0 I! i 5 aH'7P
3y0i4'~
~ .
t I FURT~iER CERTIFY that I w~l register at my local addres~ when the registration books reo~en, and comply w~ith alt
~ othei reyuirementa oE a legal resident of this State.
r
s ~
t I FURTHEZ CERTIF~ thst I hnve no intcntion to teturn to my former domicile, aad I intend W remain in -
~'m ,ZT-- 2 c~ Sr l u C 1 E _ County.
tcn>> . _ -
~
~ Fforida. perraanen~i;.
~
~
c~,,~`~'n,`'~
~ (',~~)!f ; t~'~: .
~
~ , - yl:i~i
~ ~ ? - ~ / ' ` ~
r- ~ C: , - / / i` v
~ / %
~ . ' , f ? V ll
:
. _ :
~ " • . .
~ z
'~3 - - it~iunel
~ (Addseul
;5 Sw•or nd subscribed bcfore me tAis day ol
~~~Q -
" . A.D. l9~
RA6ERr~P01 TF2AS CL K OF C iRCUI T COl~2T =
- ST. LUGIE COUNTY, FLORIUA • _
T'~ ~ Y • '
_ a
J ,
CP tERK
~ \ ~ ~
~ ~ ~ ~ hG~:~ i , ~
, ~
r.~ ; ` z
-