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' ' i nd Citizenshi . ~
Declarat~on af Dom~c le a p
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TO TliE CLEftK OF THE CIRCUIT COURT.
ST. LUC I E ~pUNTY. E7ARIDA:
TAis b~y dectantion o[ DomIcile and Citisenship is th~ State of Fforids t6st I am ~ this di?~? ;a aooocdanas. aad ia
conformitr ~rith Sectioa 222.1T. Fbtida Ststuta.
.
I ~?u formerl a kgW rs~idant ot Q- ~ , Y ~d I
n ~tCltf) ~ 1 1
st l'~ ( t=1~1.- - Nwv~ver. I have ehanged ra,~r domiciM to
. (~,wt ~d H~e1 Q
~nd ua aad bave beco a boos i'ide tesident ottM 3tate of Fbrida since , d~r ot
• 1~~.~and I resid~ at
f~~,~ ~~~t., _ ST. Ll1G 1 E N~eir1 Count~. Flocida.
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aad this statement is to be taken as n~r deelaration oi eituenalup. utwl kgal residenee aad domidb ~ ths State ot Florida.
If POR THE PURPOSE OP ENROLI.ING IF POR HOMES7EA0 PURPOSES~
CH i LDREN 1 N SCHOOI.~ P~EIISE STATE PIEASE CHECK: ~
THEIR NAMESS . -
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~ - j~r) fIL.ED 4ECVk0E0 .
St.lUC1E G3UMTlf FLA.
, AOCi.F r:+iT34S
CIERK l;inCUit GOURT
- - RECORR YE9!FICO
- ~ OcT 1 2 43 PH'75 ~
, - 318~.8z
i I FURTHER CERTIFY that I w~l register at my local address when the registration books reopen. and eomply ~?ich aU ~
; other requirements of a kgsl resideal of tbis State..
i I FUR ~ CE TIFY t I have no intention to return to my former domicile. and I intead to remain in
~~~~~j~ S T. L U t I E . County.
~ ~r1 -
~ Florida. permaaen~i; . ~
~ .
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IN~me)
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~ Sworn lo and subscribed before me this day ot f~ ~h-_
e~`"J
~ ' E
~ ~r _ A.D. l9 _ . i
~ ROGER P01 TRAS. CLERK OF C IRCUI T COU2T _
~ ~
~ ST. LUGIE COUNTY, FlOR1U `
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~ BY: ~
~
EPUTY LERK 8~~~~ P~~~^~ .
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~
AGO Porm 91-2^
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