HomeMy WebLinkAbout0139 Declaration of Dom~c~~e ana ~~j~zensn~p ~ ~
~ ~ 43~.3503 - ~
To~r~ c~n~c oF~x~ cu~curroov~rr. .
~
ST. Lt1C 1 E _ ~pUNrY. F[ARIDA: '
Tbts V au? deelarat~on at Domkils and Ctti:easbip ta tbe State of FlorWa that I am tjlins thts.da,p ia ~ccordanoe. sad in
contonnil,~? with Sectton 222.17. F'lotida Statute~. . ~
I Ka t rm a legai reaideat ot ~d _ ~ I .
~ . let~td ,
resided at ~~O~o a- L7 ~l
1 N) S~ Howewr. I ba~re ebaaged aU? domfeile to -
lehr+t a~d N~~1
snd am and h~ve beeA a bon~ Gde t~estdent oE ths State ot Fbcida dnos n~ - da,y ot
F~~ -19~ aad I r~sWe a~ N E~C.~l2~STX~
z~.~aN..w?
PoQT' S?' Lt,t e i c' ST. lUG t E ~ t;ount,p~ Flo~ida.
lClq1
tOd UlIi iL~~tD011t ~ ZO bA Li~QA i{ 1f~ ~CJtTi~l OI CI~EDiA~• ~dYi~ b$i~ ~ i~ dOf~b iD 1~10 $1~i~! 0~ ~0~1.
i
IP,fOR THE PURPOSE.Of ENROLLIN6 - If FOR HOMESTEAD PURPOSES~
~ CHILOREN IN SCHOOL~ PLEASE STATE !'IEASE CHECKS ~
TNEIR NAMES:
~ ~~p H~ ~ ~~.EO Ar)D RECORDEO ~ ~ `
°~~~E ~~UNT~~. ~~a. :
. ~ •~-J _'r.' ~ :~ri~~'
- ' - 433503
_ ~ '79 FE~ 9 ~ ~ 40
. . ~ .
' ^i__~,K C.?:.., '
.
I F'LJRTHER CERTIFY that I w~l regist~r at my local address wt~ea tl~e registntion books reopen. aad oompb ~vith aU .
other requirements ot a kgai resident of this State. _
i
~ I FURTHER CERTIFY that I have no iatcntion to nturn to m former domicik. and I Intead to remain in
j . ~ . ~ ~ C E County. ~
~ .
f lCk7)
Fbrida, penaanena; . _
sy- ' " : :y
~~titt~N U~ib/~~' ai:. :
. n 1
: ~ ~(1.~ ~~4~? .
. ~ p.~'
ti
- ,4~~~~~`~~~y,~/i •-1~ . . .
(.~.;,•,,y: • ,f'r
~ c ~ ~ ~
` , • . ~ ~ -
. , .
. ~ ~ ~
,.~,,1 ,
~"y`~-- ~ tF~~~~~ ' .
; .s~'~., ~ ; = ~,?rC~GE /4 ~iel3//v
~s.
:
- . (N~)
,
~ ~ ~C~7 ~ E FLcvz.~ s~-
I.; n! z G0; t;~ -
- ~ . .
_ '•'f~::•;i~:t:•e~1~` _ (Addt'w)
Sworn to and subscn'bed before me this dar oi Pv~T L(~[C ~ E F,~._~
. ~
~ ~ P_ - A.D. l9_ ~9 -
~ . '
ROGER PO I TRAS,,~~.,RK OF G I RGU I T COl~2T . ~
ST. LUCIE COUNTY, fLOR1DA - #
BY: ,~e~
t tr l E R K U R~~ yACE
' ~ b00X ;
,
. . • - • - ' ACO Form 71 3
:
- - - - - - _
- - -
_ _ • - - - ° Y ~
,~x'.
~;~.F=-
-