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Declaration of Dom~c~le and Cit e p
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TO THE CLERK OF TliE CIRCUIT COURT.
ST. L UG 1 E CpUNTY. FIAI;IDA: , `
Thls b my decluaUon ot Domicile and CitlsensAtp in the St~le ot F`lorida thst I ua C~lIng this da~ in ~ocordance. sad ia
eonforaaity with Sectioa 222.17, Florida Statutes.
vc ~~,e~S -~~7i0 ~I .
~ I wu iormerl a legal resideat ot
1(:~11 (Seatd
nsided at 4~ ~3' ~•~F~S.~n ~ L~., t' . Howe~vsr~ I have cbanged m~? domicile to ~
1ser..c..a tv~t
and am and have beea a bona C~de nsideat ot the StaLe oi Fiorida ainae ~7 ~
r„ - ~v~ ~ _ iS.~s - and I reside at 7J f ~'.~,,~i10 £
(8t~wt aad Nrmb~rl
/ c.• f.1'~ L~-~ F- ST . L UG I E Count~. Florida. ~
l(~t71 .
aad this stalemeat is to be takea as my declacatioa of eitiun~hip. aetud kgal reaidenee ae~d domicik iu the Stato ot Florida.
I~ POR THE PURPOSE OF ~NROLIING IF POR HOMESTEAO PURPOSES~
CNILDREN IN StHOOL~ PIEASE STATE PLEASE CHECKS ~
THEIR NAMES:
.
. fIL~L' s?, . P.~~uRDEO
, iT i~,~;~ ;J•;l~TY FLA.
F ~'<<-' ~ ~ 'R45
' r: ~~uRT
r=~~:~~. y::~..'.c'1
~ ~ I 9 s6 AM '76
3~3g~8~
I FtJRTHER CERTIFY that I will register at my local aauress when the registration books reopen. aad comply with aU
; other requirements oi a legal resident of this State.
I F~BTNER CEATIF'Y that I have ao :;~tention to return to my former domicile. aad I intend to remain in
~ /'a,~cy` ~,f. L v~. ~ ST . L U C 1 E _ County.
lt~t~l
~ Florida, permanenti; .
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~ Sworn lo and subscribed before me this day ot ~ ~Z ~ ~t` ~ ~ ~ ~~a ~ ''~j~~`
~ . A.D. 19 7 ~
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` R R" P01 S. CLERK OF C IRCUI T COl~2T
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~ ST. LUG I E COUNTY, f LOR 1 UA -
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