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Declarat~on of Dom~c~le and Cit~zensh~p 1~
TO THE CLERK OF THE CIRCUIT COURT, 33•~ 2
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ST. LUC 1 E apUNt~y. Fl,p~ttDA: •
Tbis is my decla~atioa ot Domieile and Citiseashlp in the State ot Fbrida that I aaa fillag this da~r ia aeeordsnce. and ia
eonformity writh SeeRioa 222.17. Fbrida Statutes.
I waa formerl a kgal resident ot f~ ~ M~ U~ G Q`~? o R K ~ I
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resided at ~ l~ c S T S' - However, I liave ehanged my domicile to
(St~wt ~sd Nuanb~r) -
and am aad have bean a boaa ~ide naideat ot t6e State of Fbrida siace ~ ~ ~ d+U? ~
1 ~ ~ s'` .5 ~A ,J. s H G~/',9 y
G- Tu ~3 F~S %.19~ and I ceside at
n (Senst ssd Nmb~)
. V i "S ; ~•1 G~~ _ ST . LUG I E Count~. Ftiorids.
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aad thLs statement ia to be takea as my ~antion of eitfseashIp. sdua! kgal nsidenee aad domieik in the State of Fbrida. '
IF FOR THE PURPOSE OF.ENROLLING IP POR HOMESTEAO PURPOSES~
Cl11lOREN. IN SCHOOL~ P~EASE S.TATE PLEASE CNECKS ~
THEIR NAMES:
fILfP x~? ~;COrID~Q
St. ttl~t; NTy ~1~.
' ~fl,~ , :tR~S
R C~~`.' ,-G'T COURT
=r,~. - ~ :~rn
M~r ~ I 1? PH '~S
~ 33~ ~
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I FURTHER CERTIFY that I will zegister at my local addres~ vrhen tbe registntioa books reopen, aad eomplr with all
f other requirements ot a legal resident oi this State.
~ I FURTHER CERTIFY that I hsve no intention to return to my former domicile. and I intend to remsin in
~ • ST . L U C 1 E ~ County,
IGt71
~ Florida. permanenti;.
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~ . Swom ~loand s ribed beforc me thu ~ day of G~~
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. A.D. l9 ~ 6 -
ROGER P01 AS CLERK OF C IRCUI T COl~2T
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~
~ ST. LUG 1 E COUNTY,~FI.OR i UA
~ BYs
~ ~ EPUT LERK
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AC!1 Fnrm 71 ~3