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Declaration of Domicile. and Citizenship .
4'71310
TO THE CLERK of THE clRCUIT oovRT,
ST. LUC I E COUNTY. FLORIDA:
This is uqT declaration of Demie~7e and Citisenship i4 the State of Florida that I am 81io,g this da,T is acoordanoe, and is
oootonaitT with Section 2ffi.17. Florida Statutes.
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I was f a kgai resident of *?~/~y U/ • o ~ ~ld~f ~~~~~~~~NllSorl -~fi~i'l'~d I
lawl ieta.i ~
resided at ~ ~ ~ ~5~~ ~ ~ However. I have ehaoged nq domia'le to
etrNt sad Naobal -
and am and have been a bona fde reddent of the State of Florid: ainos ~
IU n e Tl
f ~j o[
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19_~ and I reside at ~ ~~Nmb.ef l~ i
/ n ~ S ~ ~ y p~ ~-C . ST. LUG 1 E CountT, >!7oeida,
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and this sta4ment is to be taken as ~ dee4ntion oI citizenship, actual legal residence and domic>7e io the State ai Florida.
- IF FOR THE PURPOSE Oi ENROLLING IF iOR HOMESTEAD PURPOSES
CNII.DREN IN SCHOOt.s PLEASE .STATE PLEASE CHECK:
THEI NAMES:
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~ JAN -2 IIN 11~ 33
- s ~a,~NO R~cawco
P°°~"Oir~s i
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- - 4'71310
I FURTHER CERTIFY flat I wt'Il register at mT kual address when the registration booms reopen. and complT with all 3
other requireanents of a legal nesideat a~# this 34te. 4~
I FURTHER CERTII~'Y that I have no intention to retnm tom former domicile, and I intend to remain in
U C I E ~ Count~~ i
(atr) i
Florida. permanend; .
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Sworn to_' v3~ii6rn'bcd before me this ~ dad of ~ S~ ~ v r~ i-C . ?~~/Y _ ~ ~y~~
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~~n~u~ _A.D.1~.-•:. C Cct.POI ANN /VZ~SdN, ~
R06ER P01 TRASH CLERK OF C IRGUI t C0t~2T
ST. LUG I E COUNT~Yy~, FLOR 10A
BYS .iii l//lei .:~tr~~ ~ • .
EPU7Y LERK
800 ~ ~~GE
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