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ST. LUCIE COUNTr+ FIA. . ,
•Declorot~on o~ Domicile and Cihzenah~p
TO THS STATE AND COUNTY TAZ A8~8Z880R.
ST. LIICIi mUI9TY. ~IABIDA: _
This b mY decLration of Domiet~e and CltizenaLip in the $Lte ot -P'Lxida tLut I aan 61ine this day ~
accordance, and in .conformity t-iffi Chapter 29~, Section 9.17, FiorkL Statutes.
I was io:merly a Beal resWant of 8*iat01 - - - 7Tir.~ ~IIia~ _____~
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and I raided at_-----__-- ---Ii01ItT 1 --------- ----------_~-_---------. However, !have cuar ~ 3~+~•+,i.%:
(8trMt sad Na~bar)
!o And Am a*±d have been a bona tide resident of the State of Florida sinoe---------->ti4---------------------------cLY of
-
'- ~ Strw~t
--------~a~.~------------_____, 1961_, and I reside at____.___---Ag't--]f[+---lath- - --------•--------------
- (8tnst and Nnmbr)
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_-~'p~t Pi a rro e - St . Luc ie ___County, Florida,
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and this statement is to be taken as my declaration- of dtisesiship, actwl legal reddence and domicile in
the Stste of Florida.
((Lowrt hero aa' Dertiwnt !seta, weh u salo a~ yert or bo~iaa~a. oe solinvnioLmont o[ emDlo7m~at wt
tormn domkilo. removal of family to new donnicao, od Soso. eba)
Enkering Hilliaa Douglas 0>~snsin Junior High School
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FIEEG~ AND ORDER
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~j.IUCIE CuiiriT" ' `
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? FLFTFFR CERTIFY that I will register at my local address when the regiatrstaon hooka reopen,
and comply will! au other lfxjuucauciaw of a legal ::midst of thtii Stnie.
I FURTHER CERTIFY that I have no intention to return to my former domicile, snd I intend to remain
~-----------__ Fnr~__Piat4~------------------- , ---------. --~--L~~__-----------------------County, Florida,
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permanently. ---_--- f -_!_--~~--11---------_---------
(Name)
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Sworn to snd aubecribed before me this---_--_~--day of . f` ~ ~ ~ ~t i, :;~ °+:
-- l~whruaYg___----- ---, A. D. 19 al ' tiG'~~ \~ X``•~• j'~.
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(To M e:oersted in dnDliab and oz{~ln+-1 bbd wkb C'1•r)< (9reait Cwrt. and do~ip~ta•wkh Tas Awraor)
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