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Declaration of Domicile and Citizenship ~
4~14'76
TO THE CLERK OF THE CIRCUIT COURT,
ST. LUG 1 E ~p~~y,. ~,-i,p~pA: . .
This is aq~ deelaration of Doatic~e aad Cttisenship in the S4te of F7orida that I acn Sling thi~ da~ in aaordance. and 'w
conformit~ writh Section 22Z.17. Florida Statutes. ~
1 was formerl~ a kgal nsident of T~T 4 w~ , c~ aad I
. 1At7) 13taU)
nsided at ~ E' ~1( t° /ti I/ 1~ . How~ever. I have ehangcd m~ domie~e to
(8t~wt aed Nnmb~rl
and am and have been a bona fide reaident oi tDe State oi Florida sinoe y~~~ ~r. 7 q_ da~ at
.
19~, and I reaide at y s~9 PPi~/ !q E TFR R~ C L
(St»~t asd Nombor)
(~o ~2 'f' S"i' ~ ~ ei F . ST . LUC 1 E cow,~. ~.~;aa:
tac,~
and this statement is to be taken as my declantion o! citizen~hip, actual legal residenee and domitile in the SLte oi Florida.
IF F'OR THE PURPOSE OF ENROL~ING IF FOR HOMEST~EAD PURPOSESi
~CHILDREN IN SCHOOL~_ P~EASE STATE PI.EASE CHECK: ~
THEIR NAMES:
--i- 'CUi
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4~414`76
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; I FiTRTHER CERTIFY that I w~l register at my bcal addre~s when the regi~tration books reopen, and eomply wit6 iU
otber requirementa of s legal resident of tbi~ State.
~ I FURTHEA CERTIFY that I have no intention to return to my former domicile. and I intend to remain in
T. U C 1 E .~~ty.
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~ Florida. permsnenti; . ~
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; S.voro to and sabsrn'bed betore me this day of
~ - A.D.19_ .~9
` ROGER P01 TRAS. CLERK OF C IRCUI T COl~2T -
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~ ST. LUGIE GOUNTY, fLOR10A
~ . BY: ~
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EPUTY LERK ~r .r'~
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