HomeMy WebLinkAbout0767 -
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TO TILE CLERK OF TILE CIRCUIT COURT.
ST. LUC 1 E COUNTY, FLORIDA: _
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Tbls Is eny dtetsratlon of Domleilc and Cilkcnship In rho State of Florida that I am filing this day in accordance, and to
eontoraiity with Scdioa 2~.1T, Florida Statutes.
I was tormcr~ a legal resident of - ~n-~i Que ~ IV s ~'3 i ~ "L~.;_ and I _
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re:lded at ~ E• g !V -1 nQ ~ . However, I havo changed my domiale to
- tSa..t and Numt»t) .
and aaa and have been a bona tide resident of the State aI E7orida since - day of
~C ~t ~ ~ ,.19~... and I reside at - 34 2 N . F'loreS,~a Dr; ve ~_yy,Qrt S _ T.»c ~
` (St».t asd Numeer)
ST. -~UC~IE County. Florida,
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• and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
' If fOR THE PURPOSE Of ENROLLING if fOR HOHESTEAO PURPOSESt
CH1t.OREN 1_N SCHOOt.s PLEASE STATE PLEASE CHECK:
THEIR NAMES:
- None
• _ 179 SEP 25 PN !2 43
. Fil 0 ANC pECURUEO
_ - S ROGER
P~ITRAE~•
CLER•~t CIRCUIT ~T Q
RECJRO VERtF1E0_ S~ C1~~-
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I FURTIIF.R CERTIFY that I wall register st my local address when the registration tacks reopen. and comply with all
other tcquircmcnb of a Icgal resident o[ this State.
I FURTIIEZ CERTIFY thst I have no inttntion to return to my tormrr domicile. and I intend to remain in
-Port St. Lucie ST . LUt 1 E .County.
ICit~) .
Fbrida. permanenii~ . _
n G sko -
1 yUr Mara.)
- _342 N_ F1orc~Sta nl!rivr~
Port St. Lucie~JroFlo*_-ida 33457
Sworn !o and subscribed bctaro mo this y~~ ,day of
A.D.19..7r -
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