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Declaration of Domicile and Citizenshi
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TO THE CLERK OF THE C1RCUlT COURT. _
ST. Lt1G I E courrrsr, ~.oRro~: ,
This is m~ declaratioa ot Domic~e and Citizenship in the Stat,e of Florida that I am ~ing this daJ in sccordance. and in
conformit~ with. Scction 222.17. Florida Statutes.
I w a~s formerlY a iega?1 resident of e st Babylon ~ Nev~ York ~ I
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resided at 202 Arnold Ave . However. I have changed my domic~e to
(Street and Number) •
and aro aad have been a bona fide resident of the State oi Florida since 15t h d,~, ~
~`~'y .19 79 - and I reside it 18Y5 South 31st Street
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Isveee .oe rromrev) ;
rort Pierce _ _ ST. LUG I E Count~, Flor;da, :
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and this statement ia to be taken as my declaration of citizenship. actuallegal residence and domicHe in tbe State oi Florida.
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IF FOR THE PURPOSE OF ENROLIING IF FOR HOHESTEAD PURFOSES~ '
• CHIIOREN fN SCHOOL~ PCEASE STATE PI.EASE CHEGKL ~
THEiR NAMES:
19T9 .~lN -5 AM I I~ 37
~f~( CIRCtAT COUR '
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I FtJRTHER CERTIF'Y that I w11 register at my local addresa when tbe registntion books reopea, and compl~ wiib ill
~ other requirements of a legal nsident ot this State. f
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F I FURTHER CERTII~'Y that I have no intention to return to my tormer domie~7e. and I intend to remain in ~
¢ T r U C 1 E Counq. ~
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' ° ~ ~ James Francis Hall
, ~ 1815 South 31st Street '
r vs~.''• '4 j. c~~E (Addrs~a)
` ' Sth Fort Pierce~ Florida 4
; 'tortl~~ ~fp~scn'bed before me this da~ of
° June J ~ A.D.19_ ' ~
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- ROGER P01 TRAS. CLERK OF G IRGUI T COl~2T
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ST. IE COUNTY, FLORIOA
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~ EPUTY LERK ' ~
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