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t~~~~~r~~~~n ofi ~~mic~~~ an~1 ~i~ix~r~ship
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TO THE CLERK OE` T}lE C1RCUlT COURT. ~ '
ST. LUC 1 E Cp~y~ FLORIDA:
This is my declaretton ot Aomicite and Citizenship in the Statc ot Florida that I~m f~ing this day in aeeordance. and in
conformlty with Sectioo .1T. Florida Statutee. ~
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I wu tormrrl a legd re~ident ot 1V l L~ 5 _ ~ and I
ICitrl IStat~~
resided at ~5~.~ O~81 Jb' S ~1~ E - However. I have eh~nged my domicile to
(Strs~t ~nd NumOe:)
Rnd un aad have becn a bona tide resident ot thc Statc ot Florid~ aince _ dq ot .
~ G~, -19.~. and I nsidc at ,2i~ L S i~-~ 11 l~~/l~E y •
lSte~s~t and N~saser)
~o R7 S~~ LUG 1~__- ST . LUG I E County. Florida. r
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and lhis statement is to be taken as my decbntion of eitizen~hip. actual legal residence and domicile in the State o( Florids.
IP fOR THE PURPOSE Of EN:'.OLLING I~ FOR HOMESTEAO PURPOSES~
CHILOREN IN SCHOOL~ PIEASE STATE PL€ASE CHECK: ~ ~
THEIR NAMES: ~
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FILEL ~4_ ~:~„OROEO t
ST. lu~iE C~UNTr f~A. ~ :
ao~_: ==,~tR~S °
' CLErR t .;•;~T COURT~~~
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~ . Mar 18 ~ 38 AH'75 ~
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1 FUIt'f}IGR CF:RTIFY thal I~cilt regi~ter al my loca) address wher~ the registration books reopen, and comply~ ~~~ith all
other rcqairements ot a lc~;al residcnt of tl~i~ Statc.
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j I URTIIE;t CI;KTII'Y thzt I havc no inte~t+nn to return to my tormc•r domicile, and I intcnd to rcmain in
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