HomeMy WebLinkAbout0490 ' 6~~c0~~~$io~ o~ [~orr~acite and Ci~~z~~s~~~
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TO Tl IE CLERK OF Ttf E CiRCUIT COUftT. :
ST. l UC 1 E apv[~rrx. ~r.ORi~~: ,
~ This t~ my deciaration of Domicile and Citisonahip in the Stato ot Florida that I~m tili~g this day in accordance. and in '
contormity with Settion 22..''.1T~ Florida Statutes. t
I was formcrlr a Icgal resident ot ~~~~'L'/l ~ , / ~ . ~ ;~~'/`i ~ i and I '
IClty) 13tat~?
reslded at f ~ ~ ~ ~ l F ( ~r' ~c t . HoMever~ I have changed my domicile to
(Str~~t ~nd NumE~~l ,
and am and have been a bona tide tcaident oi th~ State oi F'torida siace dq oi
~ ~ f • _
- -19_ - ~ ~ and I restde at ~ Luf ~ P , `'t: .
r ~ (3trNt aad Numeet) -
t-- ST. lUC 1 E County, Florida, '
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asd ihi. s! atement is to be taken u my dee4ration ot citizenship. actusl legal residence aad ~domie~e in the State oi Florids. ~
IF f'OR THE PURPOSE Of ENROItIKG IF FOR NOHESTEA~J PURPOS~S~
CHIL~REN IN SCHOOt~ PLEA~E STA7E PLEASE CHECK2 ~
THEIR NAMESt
-7._ y,
~c~`~i~',t / ~''r J
„ , f LED AMO RECqROEO
• / ~ ' ~ T~ ^ ~ i~.IUCtE COUM~11 FIA. -
• ROCER ~a1TttA8
~LERK CIitCU1T C t!R
^R~ ~ R~FIED
Auc 10 3 ~4 PN'76
~ ~13241
I FURTIiER CERTIFY that I will register at my local address when the registration books reopen. and compty vrith all
ather requirentents o[ a Icga! resident of this State.
I FURTII~F:t CERTIFY that I have ao intrntion to return to my former domicite. and 1 intend to remain in
f.~~ ti f' ; y' ST L U C 1 E Coonty.
.
(Ciq) . . -
Florida, permanenci; .
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Sworn to and suGsc~ibed betoro mo this / d~y of
~ . A.D.1917
ROGER PO! TRAS CI_~RK OF C I RCU I T COl~2T
ST. L lJC ! E GOUN7Y, F I.OR 1 UA ~
Bv:
. EPUTY ~~KK b~Qx2g2 49~
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