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~ Declaration of Domicile and Citizenship
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TO T~iE CLERK OF THE CIRCUIT COURT.
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ST. LUG I E ~pUrrry~ t'LpgIDA: . ~
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TAis is my declantion ot DomI.ile and Citi:enship ia the Slate ot Florida that I un C~ing tGis day in aecordanos. and in ;
eoatonnity aith Seetion 222.17. Florida Statutea.
i wu io,~. ~g~,~s~nt or ~ ~ L o~~~c gr,~ cr4 ti~t.~f ~a i ~ ~
~citrl t8t.ce)
resided st .~,L( tS.~J.~.~4~s ~ A'=~ However. I luve chaaged mp domkile to {
( w~t aed Numbw) .
aad am and have M~en ar boaa fide resideat ot the State of Florida sincs ~~/Q <<- dii? ot ~
,18,2.~., aad I reside at ~ 4~ T_Q~~N,~'f f}~ rJL 1/ i~
(8tro.t.sd NumbK)
Z C-r-- ST . LUG 1 E ~ County, F'lorida.
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and tlus statemeat is to be taken u my deelaratioa ot eitizenship. actual kgal residenee and domic~7e in the Stste ~ Florida.
IF fOR THE PURPOSE OF ENROLIING IP POR HOMESTEA~ PURPOSES~
CNlLOREN !N SCHOOL~ PIEASE STATE PLEASE CHECK: ~
THEIR NAMESS '
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f1Lft? t,?i~ uG~pnOED
ST ~l;C E t: ;~+;ysy FLA.
R~ : " `'•T4AS
_ C:cRR : :~~;T G'UPT,M
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. Mar 1 ~ a4 PM'i6
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~ I FURTHES CERTIFY that I w~71 register at my local address whea the registntion books reopen, and eomply with all
~ other requirements of a legal resident of this Stste.
~ I FURTHER CERTI tl~t I have no inteation to return to my former domicile. and I intend to reroain in
vP T~. P/,L C~ ' ~ S T. L U C I E County.
~ lCit~) .
~ Florida. permanenti~ . .
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Sworn to and su f~eed before me this day ot . e C ?7 ~~F~ L
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~ ~ . A.D.19 7 ~ -
~ ROGER P01 TRA , CLERK OF C IRCUI T GOl~2T
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ST. LUGIE COUNTY, F~ORIUA
~ 8Ys
EPUTY L RK
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~ ' ~R 25`~ FA~ ~
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F•l A~f? Form 7S '~'l