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Declaration of Domicile and C~itizensh~p .
4'72456
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUC 1 E COUNTY. FLORIDA:
This is my deolarati~ of Domie~7e and Citissnship is the State of Florida that I am ~ this day in aooordanoe. aad in
conformity with $eetion 222.17. Florida Statutae~../
. I was fo~ a legal resident of ~~Y ~ ~~/rte d and I~ }
resided at ~~///Q.~'A2 / C/ ~ - _ However. I bave`ebaaged domiei3e to
(8traet asd Nomberl ~ .
and am and have been a bona fide resident oet the State o[ Florida nines I D day of
.~C~(rlJ~ .18~ and I reside at ' Q ~ ~~C~ 1/~/C~C ~
(1/C~~ ~`/~'C~ ST. LUC 1 Eatr..t,aaN.oeR1
f County. Florida, '
toti?
and this s4tement is to ba taken as my declaration of citizenship. actual legal residence and domicle is the State o[ Florida.
I F FOR THE PURPOSE Oi ENROLLING 1 F FOR NOMEST€i?u ifiiiiCi=i'r5€'
CHILDREN IN SCHOOI.r PLEASE STATE PLEASE CHECKS
THEIR NAMES:
- ,
- - .1 1980 JAN 14 Alt 53
- - F £OI~NRppR~~EC01it)EO
- ~POITRASA.
~ ~ itifiRlf tYllCUIT COtMT
4'2456
I FUR'l~R CERTIFY that I w~l register st my local address when the registration books reopen. and oomph with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return tom former domicile. and I inter to remain in
U C 1 E Counh.
1(~ityl _
Florida. permanenrt; . -
- 3
?
~;:,,I~niN1'~~~ (Name)
(Addreea)
Sworn to and subscrfbea before me this ~ day of
ROGER ITRAS LERK 0 GIRGUI T COrdRT
ST. LUG I E COUNTY, FLORID -
PUTY LERK
n~.lr.l Pl(d:~ (7•