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Deciaration of Do~nicile and Citizenship ~
TO TNE CLERK OF THE CIRCUIT COURT. ~4 Q~j Ur~
ST. LUC 1 E CpuNTY, Ft,ORIDA:
ThL~ ts mr declaratioa ot Domicile aad Citizeaship ia the StaLe ot Florida tbat I un Gling tl~is dU? ia ~ecordanos. and tn
tontormitr ~vtth Sectioa 222.1T. Florida Statute~.
I wu to~rme~rl
? a kgal resideat a~~ n! 1f E,~~,~,. 7~f . ~~t~"2 ~ and I
(~71 18taed
resided at 1- O`'~ !G .rF - Awrever. I bave ehanaed mr domidle to
(&rwt aed Nos~el / '
aad am and have beea a bona fide reaideat ot the State ot Florida siaee 2 6~ da~r °t
.Tv N' c ~ 19~.. atid I reside at _~7 8 S W.~Q ~ bR~G ~T
(Bte«t ~od Numb.H
r~r ~C LJG / G' _ ST . L UC i E ~;a,,
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and this statemeet u to be taken u m~ decluation of eitiuasAip. aetual kgal residenoe and domic~e in the State o! F{aida.
IF i0R THE PURPOSE OF ENROLLING Ii POR kONESTEAD PURPOSES
CHILOREN IN SGHOOL~ PIEASE STATE P~EASE CHECKt
THEa1R NAMESS -
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fIlEO A9C RECi'fiOfO
iL ~UCIE ~;OUNtY FIA.
aoc=F. ~a:ra~s
- CLERK Cif:;UtT COURT 1~ ~
RfCOPp YfFiFt,?:il~,,,~~
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- ,fu~ 16 I i 21 AM'16
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i I FUBTHER CERTIF'Y that I will register at my local address when the registntion books reopen, and eomptp with aU
i other requirements of a legal resident of this State.
~ I FURTHEZ CEft~ FY thst I have ao intention to return to my tormer domicile, and I iutead to remain in
~ ~,Q r"~! T L%JG ! C S T. L u c ~ E . County,
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~ Fbrida. permaneati; .
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~ ~giorn to and subscribed before me this ~ day ot T
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A.V.19 76 ~ ~ ~e'~ Y 7''"/~~%~t
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~ ROG~R POI AS1 CLERK OF C IRCUI T_ COU2T_
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ST. LUG I E GOUNTY, FLOR 1 UA ~ f,~
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~ BY t ' . ~ . •
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~ - EPUTY; IERK ~ ~ `
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