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Declaration of Domicile and Cit~zenship
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To ~ c~x of~ cr~cctrriroovnr, - -
ST. LUC 1 E ppt~y. gZ,p~pA,
Thb d m~? d~claration o~ Domk~ and Ctt~easAip in tM 8tat~ ci Flo~da t1~at I am ~lin~ tl~ ds~ io aeeordana. and in
contormit~ wit6 S~etion 222.1T. t7o~ida $t~tutes.
~ I was ! a k~al reside~ oi /~U/ ~e~~'S and I
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resided at ScJ NSe I A~/e. . owever. I luv~ ebanaad m~ domielk t,o
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and am aad bav~ be~ a bona Sde resident ot tLe 8tate d Fiorida ateee n d+~7 ~
- ---19~, ana I reside at ~ 2 / ~A ~R/St00 ~T.
ieawt ~d 1~tosb~rl
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and this statemenL b to De ta~en a m~ deelantion ot eitisenship. aetual legsl resideece and domkiik in tl~ State d F7orids.
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IF fOR THE PURPOSE OF ENROLLING IF FOR-HOMESTEAD PURPOSES~
CHIIOREN IN SCHOOL~ P~EASE STATE PLEASE CHECK: ~
THEIR NAMESS ~
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FYLlO ANC P`~Li~~~EU
ST.LUCI~co~KrY F~a.
ROGE ?OtTRAS
C~ERtt CIRCUtT CO:~,~ ~
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459411
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~ I FURTIiER CERTII~'Y that I will regis~er at m~ loeal addnss when the rtgiatration books reopen, and eompl~ with aD
~ other reqniremeats ot a leaal ~esident ot tbis State.
~ I F[JBTHEA CERTiFY thaf I have no inteatioa to return w m former domiei'k, and I iotend to remain in
~ ~,E _ T _ _ u C 1 E _ Count~,
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~ Florida. permiaeotl~ .
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. . ~ COUNTy .
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~ Sw to aad snbsQ~'bed befors ms this ~ da~ of ~7 _ GlC: c~ ~"3 ~.l
A.D.19_ 79 -
R A C ERK OF C IRCUI T GOl~2T .
ST. LUGIE COUNTY, FL 1oa ' :
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• f EPUTY LERK ~ •1 ~
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