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De~iaration of Dorniciie and Citizenship
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32~-i- ~ 1. ;
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TO THE CI.ERK OF THE CIACUIT COURT. `
ST. Lt1G 1 E ~p~~ ~~DA;
TAIs ts my declaration of Domieik :nd Citiun~hip in the State ot Florida tbat I am t~tiag thls dap in acoordsace. and ia
oontormity with Seetian 222.17. Florida Statutea.
I wu tormeriY a kgal nsident at n r~ ? J - t'rn . ~ I
l 1 let~t~)
resided at S . Hwvever. I bave elunged my doauci7e to
tStnat ~nd Nam~r)
and un and hsve been a bona fide nsideat ot the State oI b'lorida since da~ of
19- - and I re~ide at _ 3 2~~I ~ ~j t'
- . ~ (&iwt and Numeer)
~ e r r e_ , ST . L UC I E County. Florids,
lcn~l
aad this statement ia to be taken u my declantion ot citiunshtp. artual iegal reaideaee and domicile in tl~e State of ~'lorida.
~ If fOR THE PURPOSE OF ENROItlNG Ii fOR HOMESTEAD PURPOSES~
tNttDREN IN SCHOOL~ PCEASE STATE PLEASE CHECK: ~
THEIR NANESt
TeGi n
T, D.~:~,~ ~ .
f LEO AMO RECOAQED
t~.IUClE CQUNTr FLA,
ROCER PO1tilA5 ~
CLERK CtRCUIt COURT L
RfC4R0 VER~FIED~
- J~ S il s~ I~MM'76 ~
3241~1
I FURTHER CERTYFY that I will register at my local address when the registration books reopen. and eomply with aU
other requirements ot a legal resideat oi this State.
I FURTHB~~CE~'IFY that I have no intention to return to my [ormer domicile. and I intend to remain in
_ j
i e rC ~ $ T. U C 1 E . County.
~ ICit~) _
Fbrida. permanenil; . `
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l~~ ••......•Le,,:` ' IN~me)
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• : . . _ (Addew)
Sworn to and subscribed betore me this day oi
- ~ . A.D.19? 6
ROGER P01 TRA . CLERK OF C IRCUI T GOU2T .
ST. LUCiE COUNTY, FLORIUA
BY: .
E P U T Y z E R K ao~K ~ 4~7 ~A~t- 855
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