HomeMy WebLinkAbout0164 V~CId~aTIVn vT uv~~~~~~~~ a~~u v~a~~vs•~¦••r ~
~ ~ 4:;..~szz .
To ~ c~c oF rn~ cu~cvrr oova~r.
ST ~ l lJC 1 E ppUNTY. Fi,ORIDA:
. rT6is b e~? detlaratbn ot Domicile and Citimt~shjp is tb~ Stat~ o[ F7orida thaL I w t~7ioa t~is dy io se~ooe~d~aooe. aad ia
~oatonqily wilh Sectioo 2?2.17. Florida Statut~ea. . .
- .'17FG r? t~=
~ r' 1 G` 1 1 ~~I ~o ~ S andl
iI ~ras t~~ ~ kaal r~ideat oi
. {C~csl
c~sidea.t L1 0 ~ N or+. ~ s n Q S-~ t~~ ~'er. t ra.e ~d ~p domia'le to
18t~.w ~ Nrbr1
and am and have been a Doaa tde resideat ot tbe State o[Fbciila sioos - ri aS~ dy o~
19~~ wd I reside at 1 O Is S o•a.'1"S? S~ ~ Q~ n ri~1l
~8trr~tdl~l~Mr1
_ S~~' ST. LUC 1 E ~t~. plor;da.
and t1~ statement is to be taken as ~ dec}araeiou d eitiuaship. aetnal kgal nyid~nce aod dom~cae ia tLe Stat~e d Florids.
.
Ii,FOR THE PURP~SE Of ENROILINC IF FOR HOMESTEAD PURPOSES~
- CH 1 LDREN f N SCHOOI~ PIEASE ST/1TE PLE/1SE CHECK: ~
THEtR NAMESL ~
FiLEO~ AN~ R~CORDE~. ~ ~
~ ~7. ~UC~E COUNTY, FLA::'
- . r~ 1~~ i V E r~ 1 F`~ D . .
43..~t522
'T9 FE6- 9 PM ~2: 43
' A, y~
• 'til~l:f f
- CLERK Li~eu~T cov~z
~
I FiJK1~ CERTIFY thaL I wn~l re6ister at m~ loul address wlka We segi~ratiou booi~s =+eopea. and oomplJ with all
~ other requirements ot a k8a1 raideat oi tl~ Stite.
I - ~
I
f 1 FIIRTHE~ CERTIF'Y that I have ta intxntioa to return to rny lom~er domin'k. and I iatend to remain in
f ~ T. U C 1 E County.
~
/~71 - .
~ Fbrida. Permanen~~.
,
t, ;i : G~,,.~',/ .
` ` • • ~ ~r
r - . j ~L~~•. ~ ~ ' .
_ ' `'~~,y. , . +
~ - T; ~t , `
`
. . ~':v". . . 1"~
_ • ,t , _ , ~ .
"=~J - ~ IA~ ~e~~K ~51~ o~~ ~,o~»
' a .
,;,~i ~ ~o uaa~.., ,
S~rorn to and~sii ~~eribed beiore me tbit dsy af ~~t'~ ~---:-----3 3~~
~
~ _ A.D.19_ 79 .
~ - .
~ ROGER POITRAS, CLERK OF CIRGUIT CUt~tT
~ ST. Ll1GiE COUNTY, FLORIDA • . _
SYt ,
EPUTY ~ERK
~ . ~eox 3~ P~ . -
' ! r . •
i~-~ ` A('A Form 91•2~
•
_ _ _ ~ _ - - - _
;o- N.~,,~r - r
~A'"x
Yy.?-
s
I~
. '?~?s'''~` .x
. . _ _ _ . . v _ _