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Declaration of Domicile and Citizenship
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4'71551
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUC i E COUNTY. FLORIDA:
Tbis is my declaration of Domiu7s and Citisenship in the State of Florida that I am filing this dsy in accordance. and in
conformity with Section ?22.1T. Florida Statutes.
I was fob a legal resident of 0 r ~ PU ~ . ~ ~ and I
resided at ~ ~ _ "7' ~7 ~ 6 ~ S`7< • t~~) _However. I havetebanged mq? domicile to
(8treet sad Nm~Der)
snd am and have bees a bona fide resident of the State of Fbrida since ~ ~ ~y ~
~ ~ I'1 ,19~. a~ I reside at h '
( sad .
r~- S~ • I _c.a F~ ST. LUG I E qty, ,
1(St~l
and this statement is to be taken as my declaration of dti:aenship. adnal legal residence and domicile is the 34te of Florida.
IF' FOR THE PURPOSE Oi ENROt.t.ING IF FOR HOMESTEAD PURPOSES
CHILDREN IN SCHOOIa PLEASE STATE PLEASE CHECKS
THEIR NAMESS
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O r ~ ~ Ff y1 n ~o~i-?ro~SS o
_ 19$0 JAN -4 AH il= 34
FILE~~QQ..A RECORDED
STi~~o~Tai~A.
CiitCWT LOUR
Ct,ERK
RECORD VERU'IE
4'71551
I FURTHER CERTIFY that I w~71 register at my local address when the regiatntion books reopen. and comply with aU
' other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return tom former domicile. sad I intend to remain in
_ U C 1 E .County.
(C?t~) •
Florida. permanenci; .
r
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E
i
~ co ur~Ty
' •:'s ~ woe - C~ !Name) ~
' ~ ~CUNiV .
G~
Sworn to and subscn'bed before me this / day of ~ -
T
~1 i`}~J J h k . A.D.19~~ l ~ c~ i k c ~ L plr k .=1 ~ ~
ROGER PO I TRAS, CLERK OF G i RGU I T C0~2T
ST. LUG I E COUNTY, FLtJR i 0A
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f BY. 1 -
1 EPUTY L.~ERK '
p 8f,•101~( ~ PIGf 11 ~,U
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