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Declaration of Domicile and Citizenship
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To~CL>rnn oF~ Cu~C~ITOOVIrr.
ST. LUC 1 E COUNTY. FLORIDA: .
This b a4T dec4eati~ d Domidle and Citisaaship in tM State at Florida that I am thins this dsy is aooadma. aad i•
ooniormity with 8eetioa ?~.1T. F'IorWa
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I was t r r a legal resident at and I t
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u ~ g~ 9,C'~ a,~GL `llJa-(.~ ~ ~ However. I haw ebaosed w domi~iM to
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-and am end have been a bona tide resident of the State et Florida sines ~I ~ p ~ ,,t.. ~ Q ~ ~
i - and I reside at ~ ~'~O • •~i[ ~~lO.t /tom /Z~C.s-~.
l8t~t na Itseb~el
~,L ST. lUG 1 E tea,
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and this statement is to be taken as aqy declaration of dtiasnship. actual legal residence and domiails.in tM State d 1:7odda.
IF fOR T'HE PURPOSE OF ENROLLING Ii FOR HOMESTEAD PURPOSES,
CHILDREN iN SCHOOt., Pt.EASE STATE PLEASE CHECKt
THEIR NAMES:
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iLEC AtVO 'RECOROEO
. : ~sC:r COU`~TY. FLA.
. '~9 f EB Z I PM I: 5 9
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g~ster. at my local address when the registration books reopen, and comply with a0
` I FURTHER CERTIFY that I wi71 re '
~ other rcgnirements ai a legal resident of this State.
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I FUIiTHEIi CERTII~'Y I hav intention to return tom former domie~e. and I intead to remain in
F _ U C_I E County. .
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~ Fbrida. permanend; . ,
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Sworn to and snbseribed before me this ~ / day of ~ ~ - l~1 ~c-1- . 7`~9 . -~-3~`S-
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. - . A.D.19_
79
ROGER P!01 TRAS, CLERK OF C IRGUI T COURT
ST. L IE COUNTY, fL tUA
BYs ` ~
EPUTY t.ERK 300KVv~
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