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Declaration of Domicile and Citizenship - L"
4'71568
TO THE CLERK OF THE CIItCUIT COURT.
ST. LUC 1 E COUNTY. FLORIDA:
This is my declaration of Domic~7e and Citizenship is the State of Florida thst I am filing this day in aoooe+danoe. and in
conformity with Section ?12.17. Florida Statutes.
and I
I was forage a legal resident of
' l~
resided at However. I have changed nq domic~7e to
1 gad Naa~l _ /
and am and have been a bona fide resident the State of Florida ~y ~
~ a
1~ and I reside at ~
(BtrMt gad Nambt)
ST. LUG I E ~„nty,
ICltyl
and this statement is to be taken as aqy declaration ai citizenship. actual bgal residence and domid7e in the State of l`7erida.
e~
IF FOR THE PURPOSE Of ENROLLING If FOR HOMESTEAD PURPOSES
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES2
x-
1980 JAN -4 PN 12 47
S~ LUCIE
CQtlll~AS A.
ROGER Pol
CLERK CfatCUlT L_'lxlltT ~
RECORD VERIFIED
4'71568
i
I FURTHER CERTII~'Y that I wdl register at my local address when the registration books reopen. and comply with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return tom former domieik. and I intend to remain in
U C 1 E County.
ICit~) .
Florida. permanenti; . .
~
~ 00 UNTy G~~
I Sworn to and c~ 'tlF3e this ~ day of ~i5~~ /~c.~t ~
e . ~-P~
--r
ROGER POI TRAS, CLERK OF G IRGUI T COC~2T
ST. LUGIE COUNTY, FLORIDA
' EPUTY LERK ~I '
a+ arc c]ra~?J PaGE ~5 ~ f
-;r,n F~.-, _