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Q~~~~ra~~on c~f D~mic~l~ an~ Citi~~nship
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TO TN~ GL~;ItK Ol~` `fHE CIRCUIT COUItT. 3283;~i ~
ST. lUC t E ' CpUNTy. FI.QRIDA:
This b m~r decl~?rution ot Domicile ~nd Cittscn~hip ia tbe St~to ot Florida thsl I am i~ing tlus d~y in aceord~nce, and In ,
contormi~y with Scctio~ 2~.17. Florids Statutcs. ' '
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I was torm~rl ~ lcg~l rc~dcnt oI ~~h ~ ~ a+~ j •
lGt~?1 ISt~1
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~:a~a,?c 3 l'/~ 1?. :~~o ~ ~ . ltowevor. I havc changcd my domicilc to
Igt~wt ~ad NnmOer) • .
~nd am ~ad h~vc bcco a bona fidc resident of the Statc of Florida stnco n/- J ~j d+~y o~
~ - - - ls_~., and I reside_~t ~V ~ a' !r L ~ ~ f 7S l.~ ~l~ ~~PS ~l~ !3/v-
ts~e.Aax~a~?
~~.~o i... /3 t~ c~ /=`'L~'!j . ST. LUG 1 E County. b'lorid~.
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and this stuteme~l is to be tnken us my declaration ot citizenship. nclual legal tesidence and domicile in the StAte ot Floride.
IF fOR THE PURPOSE Of ENROLLING_ If
FOR NOMESYEA~ PURPOSES~
CHIL~REN IN SCHOOL~ PI.EASE STAT~ P~EASE CHECK~ ~
YHEIR NANESS
fItED At~'l RECORU~O
' ST. LUClE COUNTY flA.
ROG£~ 1 •_iT~RS
ClE~tK C:'.C::IT CaURt ; -
' RE~~>> y_: ,rlED
- F~e 1l 9 v4 AH'76
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328391 .
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~ I~FURTIIER CF.RTIFY that I will regi~ier al my lceal address wl~en the registr~tion books reopen. and eom.pl~ ~vith all •
` othcr requirements o[ a tc6a1 rcsident of tt~is Statc. '
I FURTIIC;t CF.RTIi'Y that I I~avc no intcntion ta rcturi~ to my farmcr domicilc. and I intcnd io rcm~in in
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c1 v i ST . L U C 1 E ~ , G~unly.
i o r~ c n s~ o~<<, ~ f~
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e Florida, permanen~i; . j -
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~ ~ G. I3 v., Jr ~ Z ~ s. c ~ c,~ /S ~G ~ S~~~
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~ Sworn io aaJ subccrilx~cl Uctate mc thi.v d~y o!
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ST. i~~U~!'~:iC~OUN~Y; ~_LOR 1 UA i
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