HomeMy WebLinkAbout0472 , ~ec~arat~on oT vor~~~~~~~ a~~u ~
. . 415OSg • ~ ~
~ TO TlIE CI.ERK OF THE CiRCU1T COURT. • , ~ • ~
~
• ~ ST. LUC 1 E CpUt~rrY. F~OntnA: -
?his b my decl~n?tiw~ ot Domkile and Citiscaship in tAe St~te oI Florida that I am t?ltag this da~r in accordance, and In
tontormit~? with Section 22..''.17, Fiorida Sta .
~ ~ ~ ' ( /~_h~~____._.~ 1
1 wa~ torm~~rl a kgal re~ident oI ICity1
resided ~t ~cn:
~ ~S • . HoMrever.I bave changed mr dom+cik to •
t8trMt u~ NumOKI ~ /
dar ot ~
and am and have beea boeu tide res+daat ot the State ot Florida sinee
/ ~ ~
~ 19~ and I reside at ~s~ ~ N~~l
- ~ ST. LUG 1 E County, Florida.
lC~t~1
aad this sta ment is to be takea as my decla~atioa ot citizen'ship. adual kgal residenee and domicile in the State o[ Florida.
If FOR THE PURPOSE OF ENROL~tNG I~ F'OR HOHESTEA~ PURPOSES~
CHI~DREN IN SCHOOL~ PLEASE STATE PI.EASE CHECKt ~
; ~ THEIR NAMES: ~
` ~
- ;
s
F LEO AMO RECpRDED ~
i~. LUCIE COUMTY fLA.
IiOCER POITRAS ~
CIERK CiRCU1T C
p~f';^•; Y=R!FIED ?
duc 18 10 26 AN'18 ~ `
~ • ' f
\ l
~~~0
i
~
F
I FURT~IER CERTIFY that I wili register at my local addres~ whcn the registration books reopen. and comply with all
j other requircmcnts of a kgal resident ot this State. .
; I FUR E:i .RTIFY that I have no intention to return to my formcr domicile. and I intend to remain in - i
; ~ $T . L U C 1 E _ County. ?
i
f
. (CiIT) .
; Florida.ipermanenti~.
~
~
~
fi
~ ' • -
~
~ ~ . i
~ '
~ G'`~''0
NTyc
~ ~ : ''~.fAR .O~ ? n
~ V ; : r1 ~
a ' EV~ ~ ;
~ • ' vl'-.~y~OJtME~,.wr~'5:;,~? - 3.
t ~H
~ `~C~FCGUN~' ~1~~ ~ai~~s~'~'~-i"`' ~
_ ~ II~.A.iM~~ ~ ' ~
~ O da o[ ~ ! ~ ~~~.Q ;
SM orn to nnd suhscribcd beforc me this Y ~ ;
~ A.D.19. 7 8 ` '
_ .
. - x
# R~GER P i AS CLERK Of
C IRCUI T COUF2T
3; ST. LUG i E COUNTY, f10k t.UA • :
~ _
:.F ~ .
BY : . ~
0 R z~
EPUTY IERK • 3
~ 60C~? FACE .
~ . ~
~
, 3i
_ t
- ~ AGO Porm 71 s
~ ~ " 1 _ ~ . ~ ' . '
~~"J &.r~ ~ . r~ .1.. . ~ -
%wT~
.s ^f-*s...;~_ s:P_ .:r>~,x.'~ ..r . ~a cu , -.a- ~yx~
_ r~ .
. . . x:;.! " . .