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Ueciarai~ion• o~ domicile and t~ii~izenship
,
~o~ ct.>:xx oFTI~ ~jRCUrrcovRT. 454898
ST-. LUC i E -
COUNTY. FLORIDA: s`.
~ `~'Thb b my derL~ration of Domicile and Cltiseaship is t1w State o[ Florida that I am IDias thb dq Io aooordanae, and is
eoniora~ity wltb Seef~on 212.17. Florida Statutes.
r I was i~ a legal resident at ~G ~F/~ G~ /~i9 ~ ~ _ ~ 1 U_.' ~l
E
~P
_S sad I
lCiVl 18tae~i
resided at • ~ ~ 7~~ 1 '~T2 E"FT ~ - Haweres. I have changed m7 domide to
l8en~t aai NomDerl ~
and am and have been a bons fie resident a[the Sw,e of Fbrida siaoe M ~y I ~ - dal ~ I
- ~ ti
19"79
_andlresideat ~
g~.e~ f`~~~A y~ ~ r~ ~P
. tetr••t•~d Null
~i R T 1 f. ~ CF"' ST. LUG 1 E County. b7orida.
«x~l
and this sbtement b to be taken as mf deelaratioa of dtisenship. sctnal legal residence sad domia7e in the State a[ Florida.
If FOR THE PURPOSE Of ENROLLING If fOR HOMESTEAD PURPOSES, -
CHILDREN IN SCHOOL,-PLEASE STATE PLEASE CHECKt
THEIR NAMES: _ _
454898
rats au~ ~ ~ ~ ~ s8
_ - ~~o
~~31 T'RYA~~
tY~~IT CONRT
~I I FtTRTHF1t CERTIFY that I w~ register a•L my local address when the registration books reopen. sad comply with aD
other rsgairemeats o[ a legal rrsideat ad this State.
I FURTl~Ii CERTIFY thst I Dave oo intention to return to my former domia7e, sad I intend to remain in
_ T . U C 1 E , County.
_ (City)
Florida, permanend,.
. - ~
_z~,_'
~~1~'~ e i N
_
Sworn to and subsa,3ed before me this ~ day. of ~ Y ~2 ~
ROGER POITRAS, CLERK OF CIRCUIT COURT • `y' ~
~tl~l~~!
ST. LUG 1 E COUNTY, f LOF21 OA ~*-.~,L• 3.
• EPUTY ERK ;~:`•`,c~,~a.~ ~,ti
- y~• -\N~ fit, ~~V! ~ •
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