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Deciaration of Domicile and ~itizenship ;
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32~j ~32
TO TNE CLERK OF' THE CIRCU1T COUEiT.
ST. LUC 1 E CpuN~t~ FLORIDA:
This is my deelaration o! Domicile and CitiunsAip Ia the State ot Florida tlu?t I am 61ing this da~ ia aeoordance. and in
eontormity with Section 222.17, Flotida Statutes.
I was tormerl a kgal reaident ot ~ z 9~' ~v q~~ ~9,Y~-~ .~"T !i /~U~~'2 ~i~ and I
ICiU?) 1&atd
nsided at . However.l bave ebaaged inr domicile to
(Stewt wd NumbKl - -
snd am and have been a bona Gde resideat oi the Stste of Florida siaee ~
-19~, and I restde at ~ ~d / C. ~ /l~ • i
(SteMt aad NumDesl
ST. LUCIE ~
7-- f j c-<~t coancr.
ltak7l j
and this statement is to be taken as mJr declarstion ot citiunstip. actud kgal reaidet~ce aad domieile tn the SUte ot Florida.
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- If fOR THE PURPOSE Of ENROLIiNG IF FOR HOMESTEAD PURPOSES~ (
CHILDREN IN SCHOOL~ PLEASE STATE PLEASE CHECKS ~ ~
THEIR NAMES: '
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r,y
' fllE~ ANO RECOROEO
S~.lUC1E COUNTY flA. J!'
- - ROCER POItRA3 ` ;
CLERK CIACUIT COUlIT ~
RECORD VERtFiE~~ ;
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~AN S ~0 MO ~I'~ ` ~
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~ I FUATHER CERTIFY that I will register at my local address when the registration books reopen. and comply with all
~ other requirements ot a legal resident of this Staste.
~ I FURTHE~ CERTIFY that I have no intention to return to my Sormer domieile. and I intend to remain in
~ • ` ST. LUC i E .County.
ICic71
Florida. permanenti; .
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~ ~,Stivorn to and subscribed before me thi+ ~ day ot
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~ ~ ~ « ? . A.D.19 76
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FtOGER P01 TRAS, CLERK OF C IRCUI T COl~2T •
ST. Ll1C I E COUNTY, F LOR i UA
BY: ~ c~ c~.~, o r: < d R
E P U T Y L E R K BOOK ~ Z~ F~ ~ E " O~ ~
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