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~0 THE: CLERK OF Til~ C1RCUIT COURT.
ST. LUC 1 E ~pvN'ry~ t'LQgIDA: ~
, . . ~ i
This !s my deelarstiort ot DomteJe and Citizenship to the State oE Florida thnt I aat C~ling this d~Jr in accorda~te. snd in
tontormity with Settion 2~.1~. Florid~ Statute~. .
I~?u for~~~ legal resident ot - ~ I
~ ~~t~) 9tat~1
resided at 1
SO I M~ 1~~ ~C - Hv+r~ver. I Aave ehangcd my da~uiale ta
(9t~w! wd NnmOK)
aad un and have bcen a bona fide cesideat of the State ot Florida ~i~ce v~ ~ ~7 ~
~ 19_1,,. tad I reside at ~3 3`1~ ~ a~+"R
(gtn~t nd rliunDer)
~ .9~~,(,~+~,Q ST. LUClE ~ Conaty.Florida. ~
~
cc~t>> .
and this statrmeat is to be taken u mr dectaration of titi=en~h+p. adud lega! cesidenee and domiciie in tlie State oi F'lorida. °
IF' FOR THE PURP~SE OF EHROILING ' If iOR HON~STEAD PURPOSES~
CHILOREN IN SCHOOI~ PLEASL' STATE PIEASE CHECK: ~
TNEIR NAHESS
- 1~~~~~~R~
• RI E"~ C:3CU~T ~dL'RT~~
- f c . c : £@
DEC 11 2 3i PH'77
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I FURTEIEK CEP.TIFT that I w'i:l re~ster at ny loca2 address whe~ !he registraiion books rw~~en. Lnd compty ~:t!? tll
' othec~ requiremcr~[s of a tegal resider.t of t}:is State.
~
I FURTHE? ERT~'Y that I have ao intention to return to my forni~r domicile, r.nd I iniend to remain in
~ ~x~~~_ _ , S7~ lUC1E Coun:y.
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- Floriu+a, pernaner.zi; .
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