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Declaration of Domicile and Citiienship
42891
TO THE CLERK OF THE CIRCUTi' COURT.
ST. LUG 1 E COUIV'TY, FLORIDA: ~
This is my declaration of Domicile and Citisenship is the State ~ Florida that I am Sling this day in accordance. and in
oonformit~? with Section 222.17, Florida Statutes. ;
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I was formerly a legal resident of ~ / J„~,. ~~-B~C~ and I
IC&yl ISeate)
resided at However, I have ehaagred my domia7e to
(8traat sad Navas)
aDd am and have been a bona fide resident of the S4te at Florida since t~/Q~~ / ~ ' 7~ day of
19~_, and I reside at ~ C~ .
/ ,~~'t.G ~ ~'C~_~ ( and Hamb~rl
ST . LUG I E county. F~o~aa.
ICIt7l
and this statement is to be taken as my declaration of e~tizenship. actual le&al residence and domic~ in the State e~ Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD.P R
u POSES,
CHtI.OREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES: ~
1919 OCT 17 A~; ;1. 50
FILEO RNG Q_C~nUE U
ST.LUCfE CGUVtY.ftA.
R06ER POITRAS
CLERK CiRCUiT C~3URT
f'.ECORO ~'ERIE'Ep_ _ ~ _ .
X82891
I FURTHER CERTIFY that I will register at my !Deal addt+ess when the registration books reopen. sad comply with aU
1
other requirements ~ a legal raident of this State.
I F[TRTHER CERTIFY that I have no inteDtion to return tom former domiu'le. and I intend to remaiD in
_ ~ U C I E ~ County.
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Fbrida, permanent!; . ~
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SwarD to sad sQ before me this _ I ~ day Of A'
CFA, . .79 ~ ~
R~OC,ER "~P0ITRAS. CLERK OF C iRGU1 T COI~tT
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ST. LUGIE COUNTY, FLORtOA
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BY: - - ~
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EPUTY LERK ~ =
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