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Declaration of Domicile and Citizenship
.43"J391 ;
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TO THE CLERK OF THE CIRCUIT OOUIiT.
ST. LUC I E COUNTY. FIARIDA: .
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CO[IfOiQlit~ ~Il~ ?SlC1~~l0~D '~.17. '~017di $4t11~!{. ~
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I wai tonmrl a kgal resident ~ M~-~ ~ 1~.~ • v O~' and I ~
* IQt71 l81at~) i
resided at ~n 1~e
1 i~I'eKy _ Rowever, I l~ave ehanged m~ domin'le to
(8t~t ~ed tin~l~el
aad am and bave been a boaa Sde resideat o~ tbe Stste d Fbrjda sinoe ~ da7 ot
~ .19 and I rsside at 1~ a' A 2~~
IBt~ nd Noeb.r) .
P_f'Co~ ST. LUG 1 E Coant~. F'loe~ids,
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and tAis atatement is to be Wcen u mp declaration ct citiunship. actual kgal residenoe and domidle in tbs Stste ~ Flocida.
IF fOR THE PURPQSE Oi ENROILING IF FOR HOMESTEAD PURPOSES~ ;
CHIL~REN IN SCHOOLi PIEASE STATE PLEASE CHECKS ~
THEIR NAMESt ~
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- 43'7391
'79 ! 6 ~'j : 31
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~ I FLIRTHER CERTIFY that I will register st my 1ota1 address ~vben tLe ngistrstion books reopen, and oomply with all ~
~ otber requirements of a kgal resident of tbia S4te. ~
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I FUBTHEA CERTIFY tlut I hsve no inteation to nturn to m~ former domic~7e. and I intead to nmain in ~
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R~ErR~E~,~t~~~~~GLERK OF G IRCUI T GOU2T i
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