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.Declaration of Domicile and. Gitiienship
ro rea c of ~a cuzcurr ooua~r,
ST. LUG 1 E ~.QOUI~'1'Y. FLORIDA:
This is mF deeh~ratioa d Doaaieile aad t~aaahip i~ the State d Florida that I am Sf6nE this dy is aeeordana, and in
oonlereoit, wits 8sdba ~$.i?. Flodda ~aanea.
_ . I was a ~ re~ideat d ~ and I
~~1 ~ ~J%~
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1~~_ _ - - Iio~reet. I i~avei ~
reaidsd d
tea..c..~rt..e~f •
aad sm snd ban bsea abaoafde resident oithe 8tats d Floeida dnaCT~!~1f•{ ,C/ ~l • ~~u~ ~ d _
1R ~yaod i reside at ~~C) S.' ~,cc. ~ ~ 6~/
l~swtaeiliwisd
ST. LUGIE
taa~
and this dstement is to be taken as naP deelarstlon d dtiaenship. adud lard ree3dsna and domieile in the State d plodda.
~ IF FOR THE PURPOSE Of ENROLLING IF FOR NOMESTEAO PURPOS[Se
CMI~OREN IN SCNOOLe PLEASE STATE P~E~SE~CNECKS
THEIR NAMESS .
e -
_ - ~ FEe -s ~ ~i= 30
S~ .F A.
CIttGMT t~
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~~RO YERIF~Q "
_ 4'~'S1'72
I FURTH~It (:EATTFY the I wDl resbter at ~ local address when the regidratioo boobs reopea. and eompbr with aD
other requi~ta d a MaalresideaR d this State.
I P'1JATBEIi CERTII+7f that I bare m fateatioo to return to ~ former domieik. and I intend to resaain in
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t
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b~0U111ry ?
a~leo S QcegnJ ~~rd. Oce,4? Yi/~~}e
v a,
~~~~ccLa~i.~~'`~l iAAaeeri
8woro to asd sobseried bsiore nr thin s dsf d pi ¢ 1`C Q, ~ ~it .
a?,c,,Qt~..~.~,.,i A.D. Chi /e NA Awd?RsaN) _
ROGER POI7RAS, CLERK OF CIRCUIT COtdItT
ST. LUG i E COUNTY, fLOR 10~A
EPUTY~CLERK
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