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Declarat~on of Domic~le and C~t~zensh~p
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TO TlIE CLEAK OF THE CIRCUIT COURT.
ST. LUC 1 E Qpv~. ~'l,p~DA: .
This ia mr decluation oi Domkile and Citt:enahip in the State ot Florlda tlut I am GUna this day ia accordanee. and in
conformitr w~ith Seetion 222.1T. Fbrida Statutes.
I waa formerl a kgal resideat oi , and I
, r (Cit~) (&at~1 _
nsided at ~ . Ho~rever. I lu~ ¢banged anY domki~e to
(Stn.t.edN~me~1 ~ ~aG
and un and have been a bona Gde resident of the Stste of Fbrida since day ot
19
y~ . and I reside at ~ °_~l~.z _
~ ~ ST. LUG 1 E~~x~~
~ ..~on~ ~ ~ Countr. Fbrida.
(cuil
aad this statement is to be taken as m~r deelantioa of eltizenship. aetud kgal resideaee and domic~e in the State of Fbrida.
if FOR THE PURPOSE OF ENROLLING IP FOR HOMESTEAO PURPOSES~
. CHIL~REN IN SCHOOL~ PLEASE STATE PLEASE CHECKS ~
tNE1R NANES:
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' , FIL~O tA`? ~,tYJR'~~ li
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c~~~r. cwr cosi~t ~`L
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I FURTNER CERTIFY that I will register at my local ~address wben the registration books reopen, and eomply with al!
other requirements ot a legal resident ot this State. .
I FURTHE~ ER~Y t~t ,i have no intention to return to my tormer domicile. and I intend to remsin in
a~~ iv~r . ST . L UC 1 E . County.
i (CitTl .
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Fbrida. permancnti~ .
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; -.Sw~ointo ~ytid sjibscr~~c~d 1?e[orc mc thia C, day o[
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` . A.D. l9 7;~
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~ ROGER P01 TRAS,` CLERK OF C IRCUI T COU2T
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~ ST. LIJG I E COUNTY, F~OR i UA
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i BO~I(244 P~~E AGOPorm7!-22
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