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Declaration nf Domicile and Citizenship
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ST. lUC i E ~pt~y. ~,p~A;
• ?6is b w aeel.nc;oa ol Doa~ia'le .na CieixeasAip ia u~e st.c. ot Floria. cb.c I.rn fitina chis a,U? it~ .eeoraanos. ,u~d ia
ca~o~? ~r~h Seetion 222.1T. ~'lorida Statuta.
I wa ~ a kaal resideat ot L! -t-~~~ , , uid i
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resided at - However. I 2~av~ changed my domicik to
(8~.~t ri N~brt .
asd m and bara beea a boaa Gde ~ent o[LM 3taee oL F'loeida sioos ~q ~ ^ da~ ot
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oaad
I~reside at ~~cJ ~ - ~ •
T t'SC•.1.t_~.~, , ST . LL1G 1 E~••e Nrme~ ~nc~. Flo~ida.
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a~d teis ~t i~ t~ be taken ~s m~ deefuatioa ot dtiunsltip. aetual ksal residenee and docnieile in the S4te o[ Fkcida.
If i0R THE PURPOSE OF ENROI.LING Ii i0R HOMESTEAO PURPOSES~
CHI~OREN IN SCHOO~~ P~EASE STATE P~EASE CNECKS
?HEIR NAMES: .
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I~ . • =~i ~ ~NO RECORDfD
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11ECORD vERif~EO
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35~6346 R~~o~ ini~o ~auaT i
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I FURTHF.R CERT~'Y that I wr~l regiiter at m~ beal sddress wAen t6e registration books nopen. and compl~ w?ith all
oR6er reqnirements ot a kgal resident of this State.
I FURIHE~ CBRTIFlf thst I have rw intention to nturn to my tormer domi~eik. and I inteod to remain in
' - ST . L U C 1 E . County.
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F1oc~ds. Permancnd, .
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S.racn to aod wf»m'bed before me this ~ day oi G
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-A.D.19Z7 3~ ~sv
R P01 TRAS IERK OF C IRCUI T COl~2T
ST. LUGIE COUNTY, fl.ORtUA -
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TY IERK
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