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Declaration of Domic~le and Citizenship
45~011~ ~
TO THE ~R OF THE C~tCU1T OOURT.
ST. L UC I E ~pv~. ~,p~pA: .
1Uis it m~ d~elaratba ot Domicil~ and (:Ittsenshtp io tl~s 8tate o[ Florida that I am 51in6 tLis dq in aooordanos. aud ia
. ooofa~mit~ witD S~etioo 222.17. F'lotida Statutes.
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I was i rme s kgal rsside~ at C- and I
. ' It~it71 1
resided at However. I bave ebanged m~ domieDe to
lBt.Mt as~ Nrb~) -
aad am and have been a bona Sde reddeat ot tbe State ct F{orida sinoe ~ da7 at
19 aad I reside at ~ S/ 9 S~.cl /~~x- -t'c~':~o--¢~ ,/P~Q,
~ ' ~ ~ ~ - ST. LUG I Eea..c..aN~ ~h. ~,'lorid..
tc~y~
and t~is ststement is to be taken as m~ decLration o[ citiseasbip. actwl kgal naidenoe and domic~le ia the SLte d Flo~ids.
IF POR THE PURPOSE OF ENROLLING IF POR HOMESTEAD PURPOSES~
CHILDREN IN SCMOOI~ PLEASE STATE PtEASE CHECKS ~
THEIR NAMES.
o i lca- //a ~J i979 JU? -5 A.~ I 2
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COUR
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450111
I F'tJATHEB CERTII~'Y tbat I will register at m~ locil addreas when the registrstion boo~ks reopen. and oompl~ with all
~ Ot}I!! ~111Z'!IDlll1i Ot i ~Egil f~!lldEllf. O~ ~IIS Si.iLfl.
~ I FUI~TI~R CER1'1F'Y tLst I bave no intention to retara to m former domic~7e. and I inLend to nmain in
~ • T. U C 1 E ~ Count~.
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~ Fio~rids. permanend; .
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~ Sw tosod snbsabed before ak tl~is da~ of o/~7~ c~ T_ f~ ~ e, e Q
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~ A.D.19.. ~1 3~s-Z
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r R A C ERK OF CIRCUIT COt~ZT
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~ ST. LUGIE COUNTY, FL tOA
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% EPUTY LERK .
. 6~K 311, ~E 2?18. _
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