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• ; ~~~.~t~~-~~~~~~ ~or~ic~i~ and _~iti~~::,~~~s~~~~ ~
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TO THE CLERR OFTH>r ~C[11T C4jJRT. ~ _ .
ST. LUG 1 E - - OOUN'1'Y. ~'I,ORIDA: .
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• ~ " This` ts'1~gT deelssatioto d Damidle aAd i>s tb~ State d Florida tLat I am ~ this dp is aooordaaa. and is 1
. oonfo~nit,T wltl+ Section 2~.1~. Florida Statutes. .
t~P andI
I was i s ~ resideat et
i0it,1 - 18tatsl
raided a Ha.e..r, i haw changed m~ domiAe to -
1 ~ No~1R1
. and am and bs~e been a bona Bde resident d the State d Florida since - a ~ 02 ~ dad d
- 1S~_. and reaide st ~f ~7 -~_11.~.1 ~=S ~i~+ ~'J
Iea..c..dH..>~ _
~s.~~_ /3~G.~ ~ - _ C`Q C _ ST. LUC I E Cooaq?. Maids.
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and this statement is to be takes as mP decLratioa d dtisenship. aetnal Segal residcnoe and domicils is -the State d 1:7acida.
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= iF FOR THE. PURPOSE OF ENROLLING IF;FOR HOMESTEAD PURPOSES,
CHILDREN-IN SCHbOL,•PLEASE STATE - ~ PLEASE CHECK:
THEIR NAMES: _
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° ~ - ~ ~t9 OCT -2 Ate i~ 38 ~ .
- - - s ROGf.~RCP~OIMTR
S ~ I
_ - CLERK CIRCtNT CO ~
. _ _ _ RECORO YERIFtEa
46~Oi0• i
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I F'IJAT~iER C.,EIt'1'ff'Y that I will register at m7 local address when the registration books reopen, and oomph with all
other regniretoents d a legal resident d this State. - ~
I FtJATHER Cl~iTg'Y that I love no intention to return to m7 former domieiik. and I intend to remain m
_ j u C E Coant7,
Fbrida. permaneatli
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_ .a. ~ : j~ Z Y ~ ~ ~6i~
>i, ry
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- and ~ - -this dad d ~o~:f:~tn ~
l~ 1`7F1~-b
.79
ROGE~••~1'~RAS„~ G~ERK OF C IRCUi T COLT
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ST. LUGI E COUNTY, fLOR 1 _ M, _
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BY: -
EPtiTY LERK
3~7