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Declaration of Domicile and Citizenship
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TO THE CLERK OF THE CIRCUIT COURT.
ST. Ll1G I E COUtv~1'Y, FLORIDA: ,
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This is m~ declaration ot Domicile and Citizenship in the State of Florida that 1 am filing this da~ in acu?rdance. and in
conformit~ with Section 222.1?. Florida Statutes.
Iwaslormer)valegalresidentof ring Lake ~ 1`;olth Carolina ~~,dl .
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resided at ?~4 1~ rec~a Court . However. I have chsnged my domic~e to
tStiset and N~uoDer) .
and am and have been a bona fide resident of the State of Florida since 1 June dsy of
_ .7une ,19_?9~ and I reside at 369 Tulip J31vd
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Port St Lucie - ST. LUG I E Count~, FJorida,
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and this statement is to be taken as my declaration of citizenship. actual lega) residence and domic7e in tbe State of Florid~. ~
IF FOR THE PURPOSE OF ENROILING Ii' FOR HONESTEAD PURPOSES~
CHILDREN IN SCHOOI~ PLEASE STATE PLEASE CHECKI
THEIR NAMESI
Si~irl ~homas ~hafer Jr.
vuido Alfred t•~ehrmann 1919 J'J!1 -7 !',.~i il~ S7
LIIE{U FNG nCCUttD~D
~1t~ER~P0ITRAS A~ .
i~E~tlf CtRCIlIT COUR
RFC L'ra~c~~n - f. ~--~~'~r=- ~9
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; 1 FtJRTHER CERTIF'Y that I wtlt register at my local addresa when the registration books reopen, and comply with ill
; other requirements oi a legal resident of this State. `
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i I FURTHER CERT'IF'Y that I have no intxntioa to seturn to my former domicile. and I intend to remain in
; T. U C 1 E , Count~.
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t F'lorida. permanenti;. . !
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_ orn to and snbscnbed before me this day of Port St Lttcie ,~la 33452
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~ A.D.19_
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~ _OGER_POITRAS, CLERK OF CIRCUIT GOl~2T
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~ ST. LIJG I E GOUNTY, f LOR i OA -
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; BY: ~ -Y-~c - a ~
" ~ EPUTY LERK Y A"( n~
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