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Declaration of Domicile and Citizenshi ~
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TO Ti3E I~.SRlC OF?HB CII~CUIT OOtJRT.
ST. LUG i E ppU~~ FzpglpA; '
Trig is n4 dadaratioa of Doa4ie~e and Qkiseaehip in the Stag d Fbrida that I am Sins tbia dy in aooordaaoa. sod In
oooformitT with Sadioa 8~.1T. Fbrida $tatnQtsa.
I,?as form a kRal reaiidsat d ! Dll ~ /yam F~~,t'/.t /~F/ ~D ~~t • and I
eeaiaea at _ ~ r~//qI~'~D r../ [ .S'Ju
F, xo,.a.er. I ea..`e6snged mT domide to
Is~..~..dN..l»rl -
aod am and ban been aboos fde reaidsat dthestate d Floeida sines ~daT d
SCP !'t;~, 6ct-•C ,1R,..?~ sad I reside a: d h s C iE'ySS' ~/.c~ l~iP
PDT T 1'T. Lu~°i f ST. LUG I E~~~
caul counti. Fiocida.
and tiffs statasaeat is to be tabu as my dsdaratioa d ritisemhip. aetnal Mgat seaidsaee and domio7e in tbs States d F'Iorida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOO<e PLEASE STATE PLEASE CHECK: I-`.~~I
THEIR NANESt
19~ JAN -2 PM 2 17
a"~°?.
ndaca~caT couR~ i
- RfCeR! VERIFIEQ
4'71315
I Ft1ATSEB CERTTFSf that I w~U register at mT loeal address when the registration boob reopen, and eomplT with all
other regavr+emeats d a kga! resident d this 3tite.
I FUATAF.R CERTIFY that I have no intention to return to farmer domiede. and I intend to remain in
_ U C 1 E ~ County.
(6tyl
Fbrida. permaaenci~. .
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(Addrw) _
Swore to and subsen'bed before me this ~ daj d / D.~ f~~ L!G/ L-, . 3 ~r S~'~'Z
A.D.19 y
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ROGER POI TRAS. CLERK OF G IRGUi T COi~2T
ST. LUGIE GOUNTY, FLORI~OA
EPU Y LERK
- X323 ~ 365 ~
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