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D~claration of Domicil~ and Citiz~nship
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ST. l UC I E COt1NTY. ~"t.OAmA:
Tl~b b m~r dalaration ot Domkile aad Cittzcas6tp in ths State ot Florida ths! I am GUa~ tbis d~r ta seeordance. aad in i
eoataraKy with soctioe r.~.1T, Fforia. st.wc.s. .
I was t mcr a k~at rasidept ot . ~~~a ~ ~nd T .
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te~ided at ~~1 b'?~ ~Q ~i ~~~.,t. j Ho+rwer. I ba~e ebaaged car doa4ieile to
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aad am aad have baen a boaa tid~ rsddeat ot !he Stat~ ot Florida sieas . V•~ u . . da~?
ot
~ 1l~~,. aad I ~ at ~ $ ~ ~ - -
~teMt Md Nw~~rl ~
~ ~ ~ ~Q~t ~ _ ~ _ ST. LUC I E Councr. Florida.
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and thb statem~at b to be taken as nqr decluatioa v[ dttuwhip. u~ua! kaai nsidenee and doa~dle in tM State ot Florida.
~P fOR~THE PURPOSE OF ENROLLING I~ fOR HONESTEA~ PURPOSES~
CHILOREN IN SCHOO~~ PLEASE-STAtE rLEIISE CHECKt. ~
tHE1R NAMESt
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~ iItEO ~MD REt0A0Ep
- iT.ItIC~E COUNTr.~'!
• ROOER PWTRaS
CLERK CikCUlt COUliT
ilEt~I1D YERI?~EO
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~ I FUR1'HER CERTIFY that I ~rill registsr at ray local address ~rben the registntion bovks teopen. aad eompUr with all
other reqnirecncnts ot a legsl resident oi tbis S4te.
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€ I FUR1'~IE.Z tl~at I have no inteatan to retnra to m tormer domin'le. ~nd I intead to remain in
~ ~ 1 Q i~.s . -~T . L U C 1 E . County.
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S~orn to aad :ubxr,'bed betore me this ~ dar oi p V 4 3 3~~ O
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A.D.19.~.77 . - _
$Q~~R P01 TR , CLERK OF G IRCUI T COUtT
i ST. LUG 1 E COUNTY, f LOR 10A •
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