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TO THE CLERK OF THE CIRCUIT COURT. .
•
ST". l UC I E COUiVTY, FLORIDA:
,
Yfiis is tqy declaratioa of Domica7e and L~tizensbip is the State of Florida that I am fling this day in accardanoe. and~in
_ conformity writb Section 222.19. Florida Statutes. A' j /
1 was formerly a legal resident of ~ ~ _ /Y • ~ • - aad I
(City1 (StaW -
resided at ~ Ul) ~_-.Q However. I have changed my domicile to
(Strew aad Numbst)
and am and have been a bona fide resident of the State of Florida since ~ ~ day-of
]9~.~.. aad I reside at ~ ~ ~ ~ ~ sz~~a/LQ L i
(StrreR and Numbest ~
~T - ~ 1'E,1'C~, ~ ST. LUG I E - County. Florida.
(cs~ty) - ~
and this statement is to be taken as my declaration of citizenship. actual legal-residence and domia'Ie in the State of Florida. ~ ,
IF FOR THE PURPOSE OF ENROLLING IF FQR HOMESTEAD PURPOSES
CHIIOREN IN SCHOOta PLEASE STATE PLEASE CHECK:
THEIR NAMES:
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_ ;
19~9~~~T -
_ - S8
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RaE1tKOGC ' "~1~A A'
RFCQRO t'ERrFrc~CUtT CQURT
I FliRTI~R CERTIFY that I awl register at my Local address when the registration books reopen, s-nd comply with all
other requirements of a Legal resident of this State.
I FURTHER CI~tTIFY that 1 have ao intention to return to my former domi~7e. and I intend to remain in
- T. U C I E County.
_ - (Cit~l
r'1~-~.*ida, permznenti;.
- .
- • (None)
(Addresal 7
a to and sub_~a-ibed before me this day of
- _ ~ .
- 3
:OGER F'UI AS. CLERK OF CIRCUIT COLT ~ -
ST. LUG I E COUNTY, FLORIDA ~,'~~,4 ,~-F ~ ,o
V • _ s ' ~ - a i~ _
EPUTY ERK - _ J'.7~. r.`t` G f
A, ~ ~
' l PAGE 24zS • ~ ? •.....t ,
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