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Declaration of Domicile and Citizenship
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ST. LUC i f OOUN"t'it. hi.ORID/ta
11ds i. ~ dKLratioa d DamieOs and ~ 6~ tLe State d ~'ioeida flat I ~ ~t lb3s dq is aeeo~daaee. and b
oamtaraait,T wltD 8eetioa d8l.1T. !'iseida
I was f a MEai r~aidant d L V ~Qi9 Y - V /g- and I
~aw.d at I ~ l 3 ~Q O X ~ ~ - 8o~wsvse. I Kara daopd aU? doaoids to
tSteNesa~l~i~wf .
and am and !lave ban a boos lids resident d the State d l''iodda shoe F~,b . dq d
,19,~ and I resid. at ~ 7/ 3 - 0 ,C C a n ~ ~ r
1sa~..ta.~N..r.e1
~y'. c r y ~ ST. lUG 1 E coneq. Floeida.
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and tMs statement Is to be tatea as n~ deelaration d . adwl k;al resWsaes sad domidM i• tUe State d F7aida.
If FOR THE !URlOaE Oi ENROLIINa If fOR HOMERTEAO li1RP08E3a
CHIIOREN iN sCMOOIa l~EASE STATE !LEASE CHECKS
THEIR NAMESS
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I F'[JAT~R CERTIFY flat I wi11 reamer at aq iota! address when the rspdratioo twoiu reapea. and oomph wits aR .
otitsr regmremeats d a ie6al r+ssidaN d lids &ste.
I FURTAER C.EAT1Flt that 11~ m intestioa to r+atar~ to m7 faemsr domidk, and I istsad to :ems is
~T . _ ~ u c i ~ ~ - Conat~.
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Fiorida. permao~t>;.
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Sworn to sad snbser~ed befoee me t>eis dq d i R G E _
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A.D.19~•
A K RC T O~tT
ST. LUGIE COUNTY, f OA
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