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[~~~~arat~or~ of i?r~rr~~c~~~ ar~d C~t~~er~sh~p
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TO THE CLERK OF THE CIRCUIT COURT. -
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ST. LUC i E
COUNTY. FLUtt1vA;
This is my declaration of )omiu7e and Citisaaahlp.in the State of Fku•ida tbst I am fling this day ip accordance, and in
.::o~formety with Section 27.E.I7; Fbrids Statutes. .
~j was f~ a legal resident at - S~-T ~ ~ ~ OS and I
1t~~1- - lsca?
resided at _ ~ ~ -However. I have ebanged tnr dottuct7e to {
. (§'lz~eetsadt~fmsbst) _ _ ~
and am and have been a bona foie ruident of the State of Fbrida since ~ - ~ da,T ai .
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. - . lsi~~ sad Ireside at
18trost aadNnmi+erl
Po1c
Q" g g- o~ yci
E . - ~ ST. LUG l E
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and this staterncnt is to be taken u declaration flt eitiaenship. actual legal residence and domicile in the State of F7orids, .
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IF fOR THE PURPOSE OF ENROLLINCa IF FOR HOMESTEAD PURPOS ,
CHILDREN-.IN SCHOOIy PLEASE STATE PLEASE CHECK:
THEIR NANES: - -
r~
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- I~Q JAN 22 PN 2 37
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I FURTHER CERTIFY that I w~ register at my local address when the registration books reopen, and eomg~ with au
other requirements of s legal resident of this State.
I FUR_
THER CERTIFY tt+at I have no intention to return tom fornier domia7e. and I intend to remain in
T. U C I E . Count.
t(St~l
Florida, permanend; . f -
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Sworn b and su before tree this °`O` dair of ~ r ~ tJ,x.! c '{-1t1~11~ A
S3`I 52..
-~gau0.Q ~ A.D. 29~,,,_:.
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ROGER PO 1 TRAS, CLERK OF -C t RCU: T C~tdRT
ST. Lt1G ! E COUNTY, FLOR t OA
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_ EPUTY LERK ~ .
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