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~ ~eciarativn of Domiciee and Citiz~nship
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TO TlIE CI.ERK OF THE CIRCUIT COURT. ~
ST. LUC 1 E OOUNTY. FtARIDA: , .
L-,.. a-..~•.•~r,••, n~..,~.:~.. .w.l [`iti:~*~i~in tn tM $tata e~ 1~'latidi tiut I i1f1 GI~O[ LTI~f di1 fQ i~MO. and ia
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eQafor~aity witb Secti~a 222.17. Fiorida S4tu -
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1~ra formerl a kgs! resldent ot i~ .r T~' /ti/ ~ ~~/9 `r`S. ~ ae~d I
/ ` ~/~/7~ 7~~Y ~c~y) 18w.1
resided at No~rever. I bave eban
18w.e.oa Nu.b~)~ , 6~ my dom;c~e co
at~d aa? and have been bot~a C~de sesideat ot tbe State o[ Fbrida since ~y ~
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_ , 1 aod NumD~r)
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a~d tAts st~tement i~ to be takea u a~r declaratfoa of cftiuastup. aetual kgal ttstdenee and dornielle jn the Stato oI Fiorida.
If FOR THE PURPOSE Of ENROLIING I~ POR NOHESTEAO PURPOSES~
CHIIOREN IN SCHOO~~ PLEASE STATE PtEASE CHECK: ~
THEIR NAMES: - '
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1 FUItTHER CEBTIFY that I wili ngister at mr Iocal addnsa when the registration books reopen. and eompiy aith aU
otber sequirements ot a legsl resideat of this State. _
I FURTHEZ CERTIE'Y that I have no, intention ~ return to my tormer domieile. and I inttnd to r+Emain in
~ ~ C/~ C ST . L U C I E Counly.
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Fiorida~ pernunentl;.
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_.1. ~~?4 , A.D.19_76 _
.ROGER P01 TRAS,_C~ERK OF G IRCUI T COURT
'"ST. lUC i E COUNTY, f lOR 1 oA • .
BY: • ~
. EPUTY IERK ~
. ~ ~aou26~, p~' 83