HomeMy WebLinkAbout0934 Q~ctaratio~ of C~omic~le and ~itiz~nship ~
~ ~ ~ 409'749 T ~ ~
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TO TNE C~.ERK OF THE CIRCUIT COUAT. , ' • ,
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' ST. lt1C 1 E ~pUNTY. Fi,pRIDA:
TAit is my deelaration ot Domicik and Cit~cr~.+hip in the Stats ol Fbrida th?t 1 aa? filles this d~~ ia aeeordaace. •nd in ~
conlormitr with Section 222.17. Florida Statutes. ' ~
I ~ras tormcrl s kgai nsident ot f'S T ~y/9~ ~ P~~ ~~'K - and 1 ~
ICu71 tScat~)
nsidcd at _--3 / ~L S%
- . Ho.vever. I have cAanged my domieik to -
(Stiwt ~ad Numberi
~nd am sr~d have beea a bona Gde rc~ident ot the State oi Florida aiace f T day ot
-~u I9~~ aad I residc at ~.3 ~'.S~ S` ~i~A ~'/jjo.~ 1r .C r rr
lSt~~eet asd NwoA~r? '
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o1'i T S' ~.t.c P j~~ ST . LUG 1 E County. Florida,
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and this statement ia to be taken u my dec4ration oi citiunehip. actual legd re~idence and domicile in the State of Florida.
If' F'OR 7MHE PURPOSE OF ENROI.LiNG I~ FOR HOHESTEAO F'URPOSES~
CHILDREN IN SCHOOL~ P~EASE STATE PtEASE CNECK: ~--1
THEIR NAHES. ~
s~ T~ t,~ F`n•~ ~Q ~ FJ~' -
~n~'o ~3 /~,'ja.'F,~ . .
7~~~~1 l FIlEO AN~ FIECORUE::
SL lUC1E COUMTr ~la
x ~?a.~~/~-. -
FIOGE p PO~T4a5 ~
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~ . Ju~ 13 12 Zi PN'?~
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- ~~9'749
I~'URTZiER CERTIFY that I will register at my loca! address when the registratiop books reopen, and comply with alt
other requirements ot a kga! resident of this State.
~ FURTIiE:t CE:RTIFY thtt I havc no intrntion to return to my formcr domicile. and I intend to remain in
7~ ~T 'I~! ~.[.tC~ ~ $T. ~.UC i E -County.
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Florida, pcrmanenti~ .
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Sti~•orn to nnd sulrscril~rd befurc ~~ir th+s day o( -~I • • ~ yJ ~
_ A.i). 19. 7 p
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RnGER. PnI lizAS~ CLER1; OF" C. IftCUI T COU(~T
ST. LUGIE COUNTY, FLO~t1UA ~ ~
BY;
LPUTY LCRK ~ ~ ~
~ ~SJ K f"A~f.
~?Girt'o~n,?t
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