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Declaration of Domicile and Citizenship .
4'2151
TO THE CLERK OF THE CIItCUIT (:OURT.
ST. LUC 1 E COVh~y~ ~,OgipA;
This is mT declaration of Dotoia'1s and Citiseaship is the State of Florida that I am fillnE this d~ is aeoordaaoe, and in
conformity with Section 228.1T. F7ocida Statutes.. ~
I was fob a legal resident of s _
z and I
~I n lQt~) 18teW ~ i
resided at , / S ~L_.~~/4'l~t/~e-P .~L _ _However. I have eLanged a~ domicile to
(Street sad 1~lamber)
am and have been a bona 5de resident of the State of Fbrids~sin~e ~ ~ -y~-- dad of
19~,. and I reside st r>~is ~
l$tr.etaadNa'ber)
i ~ ~ ST. LUG 1 E Flora, •
Icu,)
and this statement b to be taken as m~ daclaration of eiti:enship. actual legal residence and domid7e is the State at Florida.
t
IF FOR THE PURPOSE OF ENROLLING i~ ~i~ec ii~rwESTE:..^. P::RP:';-'.ESr
CHILDREN IN SCHOOLr PLEASE STATE PLEASE CHECK:
THEIR NAMES:
z
- 1980 JAN t 0 ~ g: 55
F ~ a RECORDED
. _ 5~~~~1TY.FLA
- _ CLElK CIRCIp)T
~T
- ~ ~'COItO VERIFIEp__._,~/~
_ ~
I FURTHER CERTIFY that I w~11 register at m~ local address when the registration books reopen, and eomplp with all
other requirements of a legal resident of this State. ~
• -
I F[IRTHER CERTIFY that I have no intention to return tom loaner domicile. and I intend to remain is i
uc ~„nt~,
1 -p
Florida. permanent(;. }
s
COUNT
vj ~
x~t~~. )
Swore co and subscn'bed before me this ~ dsy of ~ ~~1 ~ .a
~A f! a J _ A.D.19~,~ _ ~ 3 y~ 1
ROGER P01 TRAS. CLERK OF G 1 RGU I T C0~2T
ST. LUGIE COUNTY, FLORIDA -
' -
BY: .,~to-~~
f
EPUTY LERK ~R ~
EOOK~I~• PJ~GE~~