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Declaration Of Domicile ana ~c~~ze~~s~~~;.~ l
l00 THE CLERK OF THE CIItCUIT COURT. 4~~
S~-. LUG 1 E COUNTY. t-I,pRIDA; ,
l7~is is rV declaration d Domic~e and Citisensbip in the State d Fbrida that I am flies this d,y is aaordaaae. and is
- _ o~ntonoif,T with Section 2?Z.17. Florida Statutes.
~ ~r /BIAS S aod2
r.. I was i~ a kgal resident d -
/ l~7) ISt+~W
resided /!~p ~ G'/ - However. I have changed mT domids to
ISesut and Namb.rl /
and am and have been a bona fde resident of the State d Florida since C° / 7 ~ dal d
19 " - and I reside at
18tr..~t.adNomb.r)
j ~ _ ST. LUG I E
tGb)
and this statement is to be taken as mT declaration d c~tiunship. actual legal residence and domia'le in the State d Florida.
Ii FOR THE PURPOSE Oi ENROLLING Ii iOR HOMESTEAD PURPOSES,
CHIt.OREN IN SCHOOLr-PIEASE STATE PLEASE CHECK:
THElR NAMES:
/f~~ll.Am ~ACAuI~N •
C"~ A . ,~r Ac,~ ~ /eG1
1~AC ~ I ~~P~ ~ - /~'IAl' Au le 4
. I919AtlS22 P9 I~ 14-
FILEO AEkOpF~ECO~RD~EO
S ROGER
POITRASA~ '
.CLERK CtRCUlT COURT
~ ~ rAFCORO VERIFIED
l I F'tJRT'ITER CER1'>F'Y that I wfl register at mF local address when the registration books reopen, and a?mp)T with aD
' other requirements d a kgal resident d this State.
I F[1RTHER CIItTff'Y that I have no intention to return to m7 former domic$e. and I intend to remain in
j7 :
Lv~ ~ ~ Co~nt~.
_ lCiq) .
Florida, permaaend;.
GpUNTy
~ ?
Cs ~ N
~ ~ -
I v I ~ ~ ~ ~ / ~ ~ u~
~ so INS
IAda:•••)
Swam to and snbsas'bed before me this ~ ?~`daT at
- . - -
. A.D.19; 79 - ~ -
R C ERK OF CIRCUIT COURT
ST. LUGIE COUNTY, fLOR1 _ - .
. ,
BY: s CG ~
• EPUTY f`ERIC
- ~ ~~R ~5 PEE
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