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Declaration of Domicile and Citizenshi ~ . ~ ~ ~
. P ~
4'~1~`71
TO THE CLERK OF THE CIIiCUIT COURT.
STLLUG 1 E C0~lY~ ~,O~w;
This Is my declaration of Domicile and Citizenship in the State of Florida that I am Sling this day is saordance. and is
eontormity with Section 222.1?. Florida Statutes.
I was forme a legal resident of and I
- ( -7) tStat~!
resided at _ l l/ 3 ~-P However. I vs changed my domica7e to
(3trNt wd Namt"rl -
snd am and have been a bona Cde resident of the State of Florrida since ~,cn.dr ~y of
I9~. and I reside at _ / ~ ~ ~D~~~~~'C~ eC e~.~-~..
lSttMt asd Namb~e)
(r
~-?r"~,~ . ST . LUG 1 E County. Florida.
tt~teyl .
snd this statement is to be taken as my declaration of citizenship. actual legal raaidence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES
CH1lDREN 1N SCHOOt., Pt.EASE STATE PLEASE CHECKS
THEIR NAflESS
~ . ~ JAN -8 pN ~ 59
F EO ANO PFCO0~~'p~ -
_ S~l11C! COUNT1r.FlA
- C~KEL'UtCU
lT
~
A5
- RECORD VERIi(EG_.~a~~-
- - - 4'19'71
I FURTHER CERTIFY that I wi71 register at my local address when the registration books reopen, and Comply with all
other requirements ot: kgat resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain in
T . C 1 E ~ County,
V~''~~ ~'t"' Q~'rtacrl
Florida. permanenu; .
~~~dUwfyc
't~f ca„a~r ~ 10~ti'~-a~C
c 1 .
Sworn to and subscribed before me this day of ~ - 3 ~ c~ ~ 1-
p r ~
Q~~ A.D.19 y~
ROGER PO! TRAS. CLERK OF C IRGUI ~ COC~2T
ST. LUGIE COUNTY, fLOR10A -
BY: '
EPUT1f t.ERK e~~~