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TO THE CLERK OF TAE CIRCUIT COURT.
ST. LUG I E apU~. ~,O~A; ,
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This~islq~ deeLration ei Do®idle and Citi:enship in the $tab of Florida thst I am fling this dq is seoo~daooe. and is +
. conlormit~ with Saetioa 222.17, Florida Statutes. ~ ~ .
I was i rmet s legal reside. at _ - -
ttlt•W
resided at / ~J ST. - Howeeer, I leave changed mT domie3le to
Itltnst gad Numb~rl
and am and have been a bona Sde resident oithe State olFbrida since - dal d
(~~_.,bd ~ ~ .1l.~.. and I reside at
18t++~t aad
_~~,~.1J ST. LUG 1 E ~4. , ,
and this statement is to be taken as m,T declaration a[ dtiunship, actual legal residence and domi~3le is the State d Florida.
IF fOR-THE PURPOSE OP ENROLLING If fOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOt., Pt.EASE STATE PLEASE CHECK:
THEIR NANESL
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- - - 1919 OCt -8 A!! 16 -
FILEO ANL' RfCORtIED
ST. t.UCiE COUNtY. FLA.
ROGER POITRAS
CLERK CIRCUIT CO
RECORD ~'ER'~ SED ~
~ ~ 461640
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I F[JR1~R CERTIFY that I wfl register at mT lonl address when the registration books reopen, and complT with all
other requirements et a legal resident of this State.
I FURTHER CERTII~'Y that I have no intention to return to m7 former domie~e, and ~ I intend to remain is
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:~i.. u c ~ r. - Count.
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Florida. permanents;
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Swore to and snbsm'bed before me this v daj olT ~o rT ST • J C
e. - - - (~c?Obe! - ' ~ .A.D.19: ~ L;NDff L. D~Vis
, 79
ROGER POI TRAS, CLERK OF G IRGUI T COURT
ST. LUG 1 E COUNTY,- FLOR i OA
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