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Declarati~n of D~r~nicil~ and GitEZenship
+ 33225~
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TO TIiE CI.EItK OF'1'HE CIRCUIT OOUIiT.
- ST. LUC 1 E aputv~r~r. FI.C;tIDA:
Tbis is rqY declaralion ot I?omieile ~nd Citiseaahip in the &tate ot Florida that I un filina t1~I~ dy? ia uoordaaos. and i~
ooatormity rrith Scction 222.19. Florida Statutes.
G.q?~zwaod /Y~ ,J.~rS.~l .
I Mru formerlY a lcgal nsideat ot 1
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nsided at "y ~a(n.M S/ - Ha~?ever. I bave ehaaged my doraicik to
(St+~.~t ~ed Nnsb+rl ~
and am and have beea a boa~ C~de resident ot the S~te oi F'brida stnee v ~~O ' day of
/ D ~.19
7` and I resido at 3'~i ~~c`//ir~a.~/ ~ol~.R T -
IStrMt aod KMm~!
~oar c5 T ST. LUG I E ~t~.
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and this statement is to be takea as nqr declantion oi citizenshlp. setual kgsl residenee and domieile ~ the State ot Fforida.
IF POR THE PURPOSE OF ENROLI.ING IF' FOR HOMEStEAD PURPOSES~
CHIi.~REN IN SCHOOI~ PI,E/!SE STATE PI.EASE CN£CK: ~
THEIR NAMESS . -
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_ ST LUC1E C~UKTr
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I CLEF~CEF pp;TR4g lA. ~
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~ _ 332254 -
I FURTHER CERTIFY that I will register at my local address when the registntion booka reopen, and eomply wit6 all
other requirements of s kgal resident of this State. .
I THE~ C RTIFY that 1 have no int~ntion~ to return to my former domicile. aad I intend to remsia in
~02:~ ~ . L , ST . L U C I E _ County. -
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Florida. permanenti; . - -
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(edere,.1,
i Sworn to snd subscribcd bcfore mo this day of ~
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. A.D.19 7 6
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; ROGER P01 TRAS, CLERK OF G-IRCUI T COUR1'
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~ ST. Lt1GIE GCUNTY, FLOkIUA
! BY: (
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