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~ ° 1~~~~ar~r~a~ra c~~ ~omici~~ an~ Ci~iz~nshi~
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~ 35`795'7
TO TNE C[.ERK OF T~IE CIRCUIT COURT,
ST. LUC 1 E Cpvt~'t'Sr. FLORiDA: .
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Thla b my declaratioa ot Domicite and Citizcnahip In the State ot Florida tfist I an~ t~liaa thia day in acoordanee~ tod in
eonformitr v~ith Scctfon 2~.17. Florid~ Statutes.
I Mas to~merlr a kgal resident oI ~ n~' o~' ~0. u ~ w ~I o r~•d a, ~ad I . ~
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resided at QA O~Om b So n e~rc~e N. Hoaswe, I have e~anged my domicile W
- 18tn~t snd Num~rl ' {
aad am aad have been a bona fide reaident ot tho State ot f losid~ siace 1~~ d,r ~ .
~~.~r~ 6 tr ~ 19~6 ~nd I resids at O ~ ~ ~ h W a .
t~? i ST. LUC1 Esw.e.~N e~~
O r C G~7f County. Florida~ ~
" and t!?Is str?tement is to be taken as my decla~ation ot dtiset?ship~ actual legal re~idence aad donnieile in tha State ot Florida. ~
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If POR THE PURPOSE OP ENROLI.IHG ~F POR HOHESTEAD PURPOSES~
tHi1.DREN IN SCHOOI~ P~EASE ST/~7E PLEASE GHECK:. ~
THEIR NAMESS ~
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I FURT~tER CBRTIFY that I will register at my local address wrhen the registntion books reopen. and eomply with all
other requirements o[ a tegal resident ot this State.
I Fi1RTHE~ CERTIFY tlut I have ao intentian to tetusa to my former domieile. :nd I intend to remain iA
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Sworn to and suDscribed befoco me this dey o[ ~O +~'E' .~~.l C~ e. F 1 o r~~ o~, 3 3~,S Z-
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A.D.1917~
ROGER Ppl TRAS,~ CIERK OF C IRCUI T COUZT
ST. LUCIE CQUNTY, FLOFttUA •
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