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Declaration of Domicile and Citizenship .
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TO TH~ CLERK OF THE CIRCLAT COURT. • ~
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ST. LIJG 1 E apv~. ~,p~~:
T6is M apr deelar~tioe ot DoinieiN ~ad Citl~ea~bip is tbs Stat~ at ~'lo~ida that I am ~ this da,~ ta ~cooe+dana. ~ad is
eoafartaity with $eetioa 222.17. ~'Ioelds 8tatnt~a. .
i was t n e s k~sl resideoc ot ~ ~~f~r _o - aed i
( tatwl
resided at How~wr. I 6aw eDae~ed m~r domiak to .
IStr~M a~d N~Mr1 - -
and am sad 6ave been a bona Gde reddent ot t!M Stat~ ot Fbeid~ staa 3~ dq? ot .
_ ~ .
_ (1LC.G~-~~eh~ -19 ~ aad I reside at .2 ~ O ~ _ ~ • fi~ (,~.ic.c~ - - -
` • ~ a~d Nos~rl
f~~,~ ST. LUC I E ~r,
cay~ . •
and tWs st~tement l~ to be takea as ~ deelarat3on ot dtt~eaship. aetual lega1 residssee and domidla In tbs 3tate ot 1~'loiid~.
IF POR THE PURPOSE Of ENROLLINC . Ii FOR HOMESTEAO PURPOSES~-
CHIIOREN IN SCHOOL~ P~EASE STATE , PLEASE CHECK: ~ -
THEI NAMESL . ' ~
Gi.c.~-~ .
0..~.~ u../ ~^~t/l.t.,c-.,J , ST
LUC
E OOUNTY R~,~'
aoc~ ~ ~o~TR~a
" ~ ~E~ LEP.+~ ~;h~UIT COURt C~
i~F: ~IED
. IVav ~ ~~~s .
3~Di~
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I i~'URTHEK CERTIFY that I w~i ngister at my local address when the ngistration books reopea. and eomply with aU
otber nquiremeats ot a kgal nsideoL ot this State.
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; I FIJRTHE~ that-I ve rw intrntion to return to my lormer domici'le. ana I intead to nmain in r
~ ' •~,r ~.c~ ~ ST . L u c ~ e , County.
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Fbrida, permsnentl~ . ~
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Sworn to and subacn'bed betore me th~+ ~ day ot -`T ~i E12G F T_tL A•
~~7~/ytt~~~~C~~~- _ A.D.19 ~
ROGER P01 AS CLERK OF' GIRCUIT CQI~tT
ST. LUGIE COUNTY, fLOR1UA .
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BY: '
T Y ~ e a ~c ~ 24~ PJtGE1~5/
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