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Deciarat~on of Domicile and. Citizenship
4'~13i4
TO T~ CLERR OF THIr CIRCUIT OOUAT.
ST. lUC 1 E o0t>rrrY. FIARiDS:
This b np dselaratioa d Domieiia and (~Oaadip i the $tab d Flocicla that I as ~ t>ds dq i aoooeda~es, sad i
cotiformitT wlth 8eetion 228.1T. Florida StaLntM.
I was foams a kcal resideaR d ~ R c~ r~ nt nl A~ G E o R y~~ I
. iQt71 ~ tBtaW
resided at y ~N W ~Jl) Al1E R A D $owa~rr. I Hasa crasKed sq~ damieila t•
(8t~mtaadNea~erl
and am and have been a boon tide resident dthe State d Fbaidt sines ~ ~J ~.t
~ aq d
O c~ ob e r .1P~~ and I reaidsat ~ y ~ 1 N . ~~a ~r a ~ ~1 t a ~ ~ y f
t~.a,.+~..ti.~l-~
_ l- a ~ e_ rce ~ ST. LUC 1 E Florida.
cal
and this statement is to bs taken as np declaration d . aetad legal reidaeos and danie~ls i tis Stai d Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR NONESTEAD PURPOSES
CHILDREN 1N SCHOOt., PLEASE STATE PLEASE CHECK: ~ ,
THEIR NAMES:
- ~ N1~ 1 ~ ~ L C 1980 JAN -2 PM I= 28
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f~A.
_ _ aE~AK~ CiRtllli -
R~ YERiF1EQ~~
4~'i314
I FIJIiTIff.Ft CERTII~'Y the I w@l register at m1 local address when the r+e~tratioa books reopen, sad ~ with at
other requirements of a legal resident d this State.
I FURTAEIi CERTQ~R that I have no iatentioa to return to former domia7e. and I iatead to remain is
l~l U C I E ~ _ _
Florida. permanensi; .
•
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' - ~ te~die+.)
sworn to and subsen'bed before me this ~ day of ~ r ~ ~ C'_ ~ 3~ ~
ER P01 AS LERK OF G IRCUt t COt~2T
ST. LUGIE COUNTY, FLORIDA
EPUTY IERK
- - 8~3~3 364 -
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