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Declaration of Domicile and Citizenship
4'72422
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUC 1 E apply. Fi.ORIDw;
This b tqy deelaratioa o! Domicile wad Citiseaship is the State of Florida that I wan tiling this dq 6s aoooedaaoe. and is
ooatormity with Section ?22.17. Florida Statutes..
- I was tormeei a legal resident of , } and I-
tCit7) iSt~td
resided at ~ Soweves. I haw changed my domicile tar _
• (S4..t asd Nmobwl
wad am and have been a bona fide resident of the State of F7oeidawinos ~ V ~ _ daT of
C~ b ~ -198 . ana I reside a: ~ ~ 4 ~IQFI~~ 0~ A U ~ ~ -
~O~" ~ 1-. U~ ST. LUG 1 Esawcsaarlaas.~l
County. Florida. -
and this statement is to be taken as my deeLratlon of citizenship. actual legal n~sidenae wad domie~7e in the State at Florida.
IF FOR THE PURPOSE.Oi ENROLLING IF FOR HOMESTEAD PURPOS ~
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEiR NAMES:
r-~--~ X980 JAN 11 PN ~ 56
FIlEO ANp RECORi1ED
` - - ~ St LUCIF~CQUNTY.FIA.
RODE POITRAS
- _ _ .CLERIC CIRCUIT COIJR~
- RECORD YERIFItO____~ •
- ,
J- ` J - - ~ 4'72422
I F7JRTSF.R CERTIFY that I w~71 register at my local address when the registration books reopen, and comply with all
other regninmeats of a legal resident od this State.
I Fi1RTHEB CERTIFY that I have no iateatioa to return to former do 'cite. sad I intend to remain in
U C 1 E - _ County.
.i
Florida. permaaea~I; . -
_ ~ • ~ `/'nay,'} ~j ~ f ~ ~j ~
;a. ~/'~~i/t ~'Uci/~, VAS/-C.x\i_~
. ~ ~ ~ -
~t,~~~,~ ~ l~ UU/~~( HOC l~U~.
Swore subscribed before me this day of ~ - ~ U ~ ~
- ~ ~~~a ~ ~
P01 TRAS RK OF C 1RCU1 T COtdF2T
ST. LUCIE COUNTY, FLORIDA
EPUTY t.ERK ,,''rye