HomeMy WebLinkAbout0043 . . , i
.
~ 3y~'?''?'2
TO Tl1~ CGERK OF TI tE CIRCUIT COUAT.
~ ~
SY. lUC 1 E ~put~'~r. FT.O~tDA:
e • ~
'1'!ib b mr declacation ot Domieile ~nd Citi~cnahip in the Stat~ ot Florid~? that I am GGng thls day ta accocdanee. a~d (n
t~fo~mity with Scction 22.17. Flo~ida Slatute~. ~
. ~ .
I ~ru t~~m~~l a legal reaident ot M~ U/V ~ _ //VNE.~ O~It,i~ _ and I ~
. lCtt~1 13~aa!
t~s{ded a~ S^9 D~ L D l~!/V~ Q~~ V~ - Iiow?eve~. I hav~ ehanged mr domicile to
1$tnK and NumD~N
and am a~d have b~e~ a bona Cde ce~ident ot thc State o~ Florida aiaee dar oi
~~RR~ flF/~t Y .19 7 ~ - ~ad I reafde at ~ ~ /O ~ ~ ~ ~
~ IStt~t ~od NumDer)
' -r~~ ~ - . , ST. Ll1G I E
~ ~ _ Couoty. Florida.
lqc~l
aad this atetemeat ts to b~ taken as mr declaration ot eittzeo~hip. aetual kgal reeidenee and docnicile in the Stato o[ F'lorida. _
IF fOR TNE PURPOSE OP ENRO~LING IP i'OR HOHES?EAO PURPOSES~~
CHiIDREN IN SCHOOI~ PIEASE STATE PLEASE CHECK: ~
THEIR NANESS ~
. '
~ f LEO AMO RECOROEO
lUC1E COUJITY fLA.
. . AOCER ~OItRAS
. . CI~RK CIRCUIT CO
. yt?~riEo
APR IZ IO 47 AN'18 ~
~ ~~9'~''72
I FURTNER CERTIFY that I w~l registcr at my Ioca1 addresa when the rcgistration book~ reopen. and cornply witfi all
o! her rcquiremcncs of a Icgal tesident oi this State. - ~ '
` I FURT}iE~t CERTIFY thsl I Aave no intrntion to return to my former domiciic. and I intend to remsin in
; • _ ~ ST . L U C 1 E ~ County.
4 ICit~) .
' Florida, pcrmanen~i~ . .
~
o ~
~ ~
~ ~h GOUNT~,
~ ~ ~~'o~ •
~i
, - a<
. o?~
~ . ~iNtT1 ~ " ~ ! ~ -
INam~)
~ .
q ~ lo ~c ~
~ ~Addreal
~ Sworn to ~nd subscribcd bc~oro mo this .~.L=_ day o( ~~/~r~ S~~/ A~~~- b~ °
~ . . , . . ~
~ ~ . A.D.19 . ~ ' f
~
~ ROGER F'01 TRAS CLERK OF C IRCUI T COUr2T
~ ST. LUGlE COUNTY, FLORtUA ~ ~ a
~ OY s , '
~ - [PUIY LCRK ~
? ; .
~ OR
~
~ ~ ' ~ ' ' ' 3001( ~',~E
~ ~ . . ' . ~ AG(1 Pornt 7~•;» Y
~ • • .
A.:,,. _ - - - _
F l."_
u ~ ~ ° ~
~~s
;y W~~
i`Y`~' ~,dF,~~,~Crffrt ~ .
. _ _ . _ _ . . ~J~'..~..r~.. . . _ _