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4685'73
TO THE CLERK OF THE CIRCUTf COURT.
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ST . L UC i E COUNTY. FLORIDA:
This is my declaration of Domicils and Citizenship in the State o[ Florida that I am 5iins thL dq in aoeordanos. and in
eoniormity with Section 222.1?, Florida Statutes.
I wu forme a legal resident of R ~ E _ ~ ~ 4'e ~ and I
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resided at a ~ G O / /'`FPFP ~ - /f~ T. Q 'd /j'~ _ However. I have changed my domicile to
Ist<..c..arrse.r? ~
and am and have been a bona fide resident aE the State otFlorida since / O Tr1 day of
s~ / d ~t ~ 18~,.~. and beside at / ~(,Z S. !.a .sf ?.4-lrc~ ? o .
Ietr..t.aaHme.tl ~ 1
P ~ ~ Sr. ~ c ~ r ST . L uG I E ~ Count,. Florida. ~
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and this statement is to bs taken u my decoration of citizenship. actual legal residence and domicile in the State a[ Florida.
IF FOR THE PURPOSE Of ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK: ~---J i
TNElR NAMESS
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485'73 { . i
I FURTHER CERTIFY that I w~ register at my local address when the registration books reopen. and comply with aU i
~ other regnirements at a legal resident of this State.
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E I F1JRT'HER CERTIFY that I have no intention to return to my~formei~rdomiede. and I intend to remain in
r-'- ~ County.
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Florida. permaneati; .
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sworn to and :n ore me this day of O R T ST . 1 U c 1 E. _ ~L 0. , -
A.D.19_ A~~eRt /V Sa.FF Old
~ - ROGER P01 TRAS, CLERK OF G 1 RCU 1 T GOURT ~~A~l S4.-FFoI d
ST. LUGIE COUNTY, FLORIDA
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EPUTY t.ERK
a~3~1 ~~i96~ , _ l