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TO TIiB CGERK OF TtiE ClRCU1T COURT. "'~+i~
ST. LUC 1 E Qp~. ~,p~DA: t
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Tbt~ b m~r d~eluatlon o~ Domkile and Citluaship ia tM Stat~ ot ~'lorjda tAst I am Wina lbb dy iu uoo~+dana. u~d ia
coatamity ~?ith Seetion 222.iT. F'lo~ida Statuty. ;
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I wa Iormer a le~aa! nsideat o~ ~ . aad I
~3 ~ ~ r.t1.~ r ~~-oc `
e+aided at ~-~-R Hoatnee. I baw ebaa~ed mr domieile to ~
Iatr~t ~ N~~1 • .
aad ua and have beea a boaa C~de e+esideat ot tAe Sbt~ ot Fbcida ainc~ ~ day ot
19...~Z, ~ad I resid~ at T a ~ ~ i
lStnK ~d NreeKl !
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~ ~v~i~ ~ ST. lUC1E
Couocr. Fbrida.
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" aod tha stateaunt is to be takea u m~r dee4ratioa of eit~eeuhip. aetua! kgd reaideoce aud doa~ia'le Ia tl~e State ot Fbrida. '
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Ii POR THE PURPOSE Of ENROIIINC IP FOR HOMESTEAO PURPOSES~
CNILOREN IN SCHOOI.~ PLEASE STATE PLEASE CHECK: ~
THE i R NAME"S:
G~G7/t~7A~ ~ l.l.t~~
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~~IEroC~0~11TY ~LA.
ROCER POITIII~
~ CIER[ CIRCttIT COUAT
Y~ali1E0
~ Ju~ I B 10 22 AM'1T -
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~ I FUBTNER CERTIFY thst I~71 register at m~ local addres~ ~rhea the registtation books rtopen. and comply ~rith all _
ot6er requiremeat~ ot s legal resident of this State.
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{ I Ft1RT8E;i CEftTIFY thst I have ao intcntioa to tetnrn to my tonner domicile. and I inlead to remaia ia
' ST . L U C 1 E , . CouAty.
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~ Fbrids. peraunenti~ .
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S~rarn to and subxribed before me tt~b ~ dar oI ~ ~ ~ 3~~
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~ A.D.19 7? -
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~ - G R S CLERK Of C IRCUI T COl~2T
ST. LUG I E COUNTY, f L.OR 1 U ~ _ ~
~ BY:
~ ~ ePUTY ~eRx
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