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- 4~i42'72 - ~
TO THE CLERK OF THE CIRCUIT OOiJHT. _ -
ST. LUC 1 E OOUNTY. FLORIDA: -
TDis is'bq~ declaration d Domic~e and Citizenship in the State d Florida that I am filing tDis daT in aooordanoe, and in
oonformitT with Section 222.17. Florida Statutes. Q ~ _ .
- I was forme a legal resided of • ~ y'
~ It~4Tl 1&at~l i .
li
resided at Aowever. I have eDanged mF domicile to ~ -
IStr«t NumD~ - - ~
and am and Dave beea a bona fide resident of the State of Florida since ~ ~7 d
19~~ and Ireside at ~l/ ~ ~
18tr.d aad I1omb~c~l
ST. LUG 1 E r
.t1~~e Corm >!7orids,
IC~s1
aad this atateme~ is to be taken as ~ decoration d dtizensDip. actual legal residence and domia7e in the State d Florida.
IF fOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NANESS - ~ I'
;i
? ~ l9T9 SEP 25 f'~ 2~ 51
FILED Ak0 FECOdDtO
S ROGER
P6ITRASA-
CLERK CIRCUIT CO T
RECORD YERIFiEO
~~~IGr a
f E
I F~ CEBTIFY tDat I w~71 register at mT loch address when the registration books reopen. and eompl~ with all j
other requirements of a legal reaide~ d tDis State.
I FURTHER CER1'Il:~ I have no intcn ' to return to m~ former domicile. and I intend to reauin in
r ~ u T. U C I E CoalntT,
- iG"~t7)
Florida. permanend~. ~
. ~
C4~'~0~1 -
ice.
i~_
n~_ ~
~ . IAddrawl _
Sworn to and snbsmbed before me this ~ `5 daT d
~~R PO 1 TRAS. CLERK OF C 1 RCU I T COURT
ST. Ll>E i E COUNTY, FLOR i OA -
BY: -
EPUTY LERK ~