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Declaration of Domicile and Citizenship
4'71311
TO THE CLERK OF THE CIRCUIT OOUAT.
ST. LUG t E -COUi~I'1'Y~ 1.3.ORIDA:
This is mT declaration of DomJdb and Citisesship is the State at Florida that I sm fi4na this dy in aooordana, and in -
caniaemit~ with Section 222.iT. Florida Statutes. ~
I was f rme a legal resident of ~~t.•~-.~-~~ L and I
resided at ~~~a / lt~ .~~-CU ~C,' Hawevar. I have e6anged ~ domia7s to
l&rwc nd Nenbw? -
and am and have been a bona 8de resident of the State apt Flodda siaoe da,Ir ct
I`-~~ . 19~ and I reside at a~ S~ W
~..2i - ~ d.~c.c.~e.J y ST. LUG I E~ CountT, Florida.
tG41
snd this statement is to be taken as my declaration of dtisenship, actual legal residenos and domie~7e in the State a[ Florida.
IF FOR THE PURPOSE OF ENROIIING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLE~ISE cHEtKS
THEIR_NAMESt
~ -
r 1980 JAN -2 AM il= 37-
~LE~ANC RECOit0E0
. ~ ~e rnottTY.ELA.
- R POITRAS
- ClRCU1T COUIt
~ 1ifRIFtED
4'71311
I FIJBI~3ER CEBTIF'Y that I wdl register st my !Deal address when the registration books reopen. and aomplT with all
other requirements of a legal resident ~ this State.
I FURTHER CEIiTII~'Y that I have no intention to return tom former domicile. and I intend to remain in
- - U C 1 E . Count.
tcs~>>
Florida. permanently .
C~UN
rt~`:r F~~~\, 1N
tAea~...~
Sworn to and subscn'bed before me this ~ ds~ of - s ~,c.~c.~ , ,
A.D, i$,~,
ROGER POI IRAs, CLERK OF G IRGUI T COrdRT
ST. LUGIE COUNTY, FlOR1DAQ ~ -
EPUTY t.ERK '
~e~c~ i
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