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~?~c~~r~~a~n of ~~m~Gi~e ar~a~ ~~~~~~nship ,
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TO TliE CL~;IiK Or` THE CIRCUIT COURT. • ~1`;~~
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Thts is mr declaratio~ ot Domicilo and Citkenship tn the SU?to ot Fbrid~? that I~m CJing tMs dU? in aeeordanco. iu+d ia
contormily with Scction 2~,17. Florida Statules. • ~ ~
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I was tormcrl ~ Icgal res~dcnt oi ' ~ • ~2~ i ~
_ ~L~ ~ (Cit71 lSYatel
restdcd at . liowaver. I havc changed my domieile Lo
lStr+~t Nuanbsrl . -
aad am ~nd have bccn a bona lidc residcnt ot the St~to ot Fbrida since ~dny ot
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19~, aad I reslde at ~
- StreK and Numbetl
- ' ST. LllG County. Flortda,
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and thts statement is to be tuken us my declaratioa of citizenship. actunl legal r~sidenee aad domicile in tho State ot Florids.
IF FOR TNE PURPOSE OP ENROtLING . If FOR HONESTE/lD PURPOSES~
CIi1L~REN IN SCNOOL~ P~EASE STATE PLEASE CHECK: ~
YHE NAMES:
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A ST
lUClE ,.OilhtY FLA,
!0&Eh : ;ITRAS
CLERK Ci~G;Jt1 COURt
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. A~ 11 Z 4s PN'75
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I FURT}IER CF,RTIFY tha~ 1 will regi~tcr al my local address wl~cn the registration books reopcn, and comp)~• .vith all
other r~quircments oi a lcbal resident of this State.
~ FU TII CCRTII'Y that I havc no inlcntion to return to my farmer domicile. and I intend to remain in
~5~~~-~='~--~~~ ~ , ST _ L u c i E -
' . C.~~unly.
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~ Florida. pcrmanentiJ.
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$worn lo enJ su!?scril,ed bcforo mo thiy ~ day ot _~~_-~L p~~~_~~~~~---~~
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, a.n. 7.5~
; ROGLR PO _ AS~ CLERK dF C IRCUI T COUtT
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