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.Declaration of Dam~c~le and C!tlzensh~p
~'~3883 -
TO':
HE CLERK OF THE CIRCtJ1'f COURT. -
ST . L UC 1 E - COUNTY, FLORIDA: •
This is~mT declaration of Domicfie sad Citisenship in the State of 1s9orida tna! I am Ding this d~ i>s aeoordanoe. sad in
oontoriaitr with Section 222.17, Florida statutes. - -
- - I was forme a legal resident of --~/t'H'a- ' and I '
- t IStrW -
resided u ~ 3 ~ A - /~J;/~~ - - However. I love changed and domide tp
- - tsw.t.ea N®e.r? - -
and am and have been a bona fide resi.ent of the State ofFlorida since - d+U ~
p~
• 19.0=' and I reside at ~ ~ ~ ! • ~
ST. LUG i E _ ~;d;,
and this statement is to be takes as mlr declaration of dtisensbip. ae3aal legal residence and damkib in the State aE Fbrida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HO'~IESTEAO PURPOSES,
CH 1 LDREN 1 N SCHOOL, PI.E/CSE STATE - PLEASE CHECK:
THE 1 R NAl1ESZ .
_ ~ ~ 1980 JAN- 24 Ply ~ 0 t -
- _
- fILE01?NO RECtIKUEO-
r - ~ ~ - S
R~ER
Fa1RA5A
v~
- CLERK CIRCN
~ _
- RECtH!L~ ~'cR1F1~11
-
%~'1 4'7383 -
. - _
I FURTHER CERTIFli that I wdl regnder at mT meal address when the registration books reopea, a~ comptT with alt
other requirements d a legal resident at this State. - -
i -
I F1J41'I~FR CERTII~R that I Issue ew intention to return tom former domidle. sad I mend to remain is
( _ U C 1 E , Conntj,
_ _ cc~l -
1~7orida, permanea3; . ~ -
_
- ~ coin, - - .
~•'f c'_T•. ~ i
•z ~ -
V: -
- - - i _ ~9 - / I = mil/ ~ J ~i /T ~
~ y:~__-
cAda""' I:
. $wocn to sad sabsrnbed before me this daT d
~ A.D. i
ROGER P0ITRAS. CLERK OF ClRCUI T COt~T - -
. -
ST. LUGiE COUNTY, FLORIDA •
- -
~ _ EPtITY t.ERK
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- X32
. i
- AGf7 Form 71 22~