HomeMy WebLinkAbout1044~3~~~c~!'al:lC.~tl Q~' ~C~C~~IGIf L' i3tl(,~ ~t~i~.:C-I~Slllc~ '
' 514'~55 ~ ~
~'0 THE CLERK OF THE CIRCUIT COURT. ~
_ ST. LUG 1 E COUN't'Y. FtARIDA: ~ •
This is m~ decLration oi Domicale and Gtituenship in t6e SLate of Florida that I am.~ilin~ this da~ in aaordana. and ia
~o~iormit~ ~itb Seetioa 222.17. Florida Statutes. ~ .
I M~as formerls a 1ega1 resident oi / ~G-
, ~a t
_ ~ tc~a,~ ~sw~
resided it Hoa ever. I bave ebanged m~ domip7e to
(S•aeet and ~be~ ~
P nd nm and ha~ e been a boaa Sde resident oi tbe State oi Florida sina l~ ~ L- da~ ad .
, .~ _~~ .
_ _ 19~ ~, and I re~;de at
, (Street sa N 1
~ ' ' ST. LUGIE • ~
- I~7) _ Count~, Florida.
r. nd thu statement is to be taken as my detlaration of citiunship. actual legal residence and domia7e in tbe State oi F7orida.
" IF ~OR THE PURPOSE~O~ ENROLLING IP FOR HOHESTEAD~PURPOS.ESi ~
CHII~REN IN SCHOOL~ PIEASE STATE PLEASE CHECK: ;~"
THEIR NAMES: • ' `" ~
1981 J~N 23 PE', ~ 09
~ F1L[C ~1~C Fi LOMD! 0
~ ST.tUtlf COU~~Y.fl A.
ROG~R POiTR.15 /~
CLEFK C!?:1::' ~'~ ' ~'(~
.'•_EF: ~•j t ~s : ~ ~- ~-
~ 514'755
I FURTHER CERTff'Y that I a-71 register at m~ loca] address when the registration books reopen. aad eompl~ wit6 a11
; o:her requiremeab of a Iegal resident of this SLate.
~ I FURTAEH CERTff'Y _ that I bave no intection to retura to m~ tormer domie7e. and I intend to remain in
, J T, L u C 1 E ~~t~.
i (6q) .
~ r ,c-ida, permanen~i;.
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~`-~ ~ o-a to and snbsrnbed before me this ~ da~ ad
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~ , ~.. / 98/
; ROGER POI TRAS. CLERK OF C IRCUI T COCd~T
~ ST. LUGIE COUNTY, FLORtOA •
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. EPUTY I.LERK
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