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Declaration of Domicile end Citizenship . ~ _
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TO THE CLERK OF T11E CIRCUIT COURT.
S f LW c ~ C COUNTY. FLORIDA:
Thb Is my declaration of Domkile and Citiseasbip in the State of Florida that I am Celina this day to aetordanee. and is
eontormity with Section 222.17, Florida Statutes.
I was tormerly a legal resident of T~ Ro M T O U NT 2 l L~ N~~ and I
tCltyl (tale)
resided at T/ d S (ft ~ 30R o i.7 R ~ ?C - . However. I have changed my dotnieile to
(&nN sad Nvffit~rl
and am and have been a boas Cede resident of the State of Fbrida stare ~ ~ ~y of
/74~ GOKdN/1n0 AVC '
S i p yP m d p _ 19 6
D and I reside at
(St»et aed NsmDKI
i= T- 1 E12G S T L u G i ire County. Florida.
lClgl
and this statement is to be taken as my declaration of citizenship. actual legal residence sad doaucile in the State of Fbrida.
FILED AN0 RECORDEDf • f
LUCiE COUNTY. f1.A'
438825
'79 MAR 28 AM 9:26 F
- ~ F
ROGEi? ~U~TR:-S •
• CLERK CIRCUIT COURT•
I FURTHER CERTIFY that I well register at my local address whoa the registration books reopen. and comply with aU
other requirements of a legal resident of this State.
~ I FURTHER CERTIFY that I have no intention to return to my former domicr7e. and I intend to remain in
S t u [ / ~ County,
s (City)
n
Florida. permanently.
~ .
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to
/Z tt ~~p~F Ale vd HENN
lN~l •
/70~ CORoNIin/~ Avt;''
l/ldd+rn)
Sworn to and subscribed betore me this ~ day of i'S • P ~ ~
~ ~ t , r ~ • 3 3 S O
A.D.19~
Gz--~•-
8tat~ at at Larp '
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# ~ 3,~IiiiON QWItES 1`lJGl1ST 11. 1919 t
'ls,~ a a " tfW COAL 11~. tJt~CERVVRIiE~S
K a? ~ -tf' rte..:., •.W~. ..W.
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AGO Form 71