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Declaration of Qomicile and Citizenship a
.43.3153
TO THE CLERK OF THE CIRCUIT COURT. ,
ST. LUC 1 E COUNTY. FLORIDA:
. Tbb b my dselaratba ~ Domicile and CitirAaship ~ tM State of Fbrida flat I am ~ this day iu aeoordaaoe. snd to
conformity witb Section 1:22.17. >E'lorida Statutes.
I eras i~ a legal r+ssident of ~ ie'u'4"' - • sad I -
lt~tatd
resided st O However. I Gave ebanged ~r domk~7e to
( asd Nesfl~l
and am and bane been a bona tide resident ottbe State otFlorida sinus ~ ~
19 - Ip - and I reside st O S
- 18tnct aid Nw~bul
_ - ST. LUG I E County,l`9orida,
last
sad this stateapeat is to be taken as W? declaration of eitittaship. actual legal residence and doanieile in the State o[ Florida.
• IF.fOR THE .PURPOSE Of ENROLLING IF iOR HONESTEAC PURPOSES,
' CNILOREN IN SCHOOL, PIEASE-STATE PLEASE CHECKS
THEIR NAMESS
FII:EO'A~lt~° aEC~ -
ST. LUCIE COUNTY.~f '
CCRD VcRiFIEO
• ~ ~.3.31~53
- 'i9 f E6 6 Pirl 2: 1 5
- , tT', ,L
CLERK CtRCUtT COURT
I l`'URTHER CERTIFY that I will register at my local address when the registration books reopen. and comply with all
other requirements of a legal resident of ibis State. -
I FURTHER CERTIFY that I have ao intention to return to my former domicile. sad I intend to remain in
I =--T v~ :~'~I" county.
~ IQiyl
Fbrida. permaneatl; .
L ~ t!i?t71f/
~y ~ ~3~
~ ~ _
' - ~ ` ~
Sworn to ad" . ~etore ate this day Of ~ gV' " - ~
A.D.19_ ~I -
RpCER Pt71-TRAS. LERK OF CIRCUIT COURT
ST. LUGIE COUNTY, fl.OR10A
BY: ~ •
- EPUT RK
~ooK ~l2 ~A~~ 2599
AGO F'~.rm 71 2,'? _
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