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~ . 3~E~'7~`7 .
TO Tli~ CLERK OF T11E CIItCUIT COURT.
ST. Ll1C 1 E -(~UN'!'Y~ FIARIDA:
This is my deelaration of Domicile and Cilisen'hip i~ tho State ot Florida tha! I am C~ling this dq? ta accordaaee. aad in
coato~mity with Seclion 222.17. Fbrida Sta ute~. ~
, ~Vl~/O~? ' l~~,•,~~ u~dl ~ .
I w+w ~or~
r~ a k resident oI
ICltrl . 1&ae.I
a~ ~ ~C Hmaever. I have ehanged my domie7e to
~&reet a,od Num~r) 1'~, '
and d have bcea a bona tide resident ot the State of Florida aince f~~ da~r ot
ig~ aad I reside at !~~`r V~~ .
..L.- l8tewt aad Numb~rl
/_~l ~1~~. Iri ST_ L~ ~ L (~~u_nf~r i.'lnrlrl~~
v ~?A/N - G ~ / . - -
ICIt~)
and this statement is to be takca a~ my declualiop oi eitizenship. ~etu~i kgal resedenee and domicile in the State oI F'brida.
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IF POR ~NE PURPOSE OF ENROIIING IF POR HOMESTEAO PURPOS~S~
CH(_LDREN IN SCHOOL~ PLEASE St/1TE PLEASE CHECK: ~
THEIR NANES: .
i
~ I FURTIIF.R CERTIFY thAt I will re~{ister at my loca] nddres~ when the registration books ceopen. and comply with ali
~ olher requircmenis o[ a Iegal resident o( this State.
I FUliTi1FZ CERTIF~' that I havc no intrntion to rcturn to my formcr domicile. and I inlcnd to rcmain in
S
~ • _ S 7. L U C I E , County,
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Florida. permanenti; . ~
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~ Sworn loand subscriln:d tH•foro mc ll~is ~ day of / D-~ -
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~ C,t' .4~! . A.D.19 ~ 6
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~ BYi?-~ ~3~ OCt 59~ °
~ ,s'''y;:.:.;•. . Ef'UTY LERK '
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