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c! ration of Dornicil~ and ~i~i~~nslii Y
D~ a ~
4'783'4
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E QOU~y, Fq,O~pA;
This b m,T deeLration of Domiei7e and (Stiunship is the State at 1'7orida that I am filing this dq is sooordanae. and is
eaaicrmitT with Section 222.17. Fbrida Statutes.
I was i~ akgal resident at ~~iy~l.'~i~lJ'~T'~.lJ ,UE!!> Y.e,~ andI
l~ teut~d
resided ai ~_~',~Tf~~-.e S7' .~e~T ~f ~ - Howe~r~. I have ebanged aqT domie~le t+e
Ifitre~t and I~1.eD~e1
sad am and bave been a bona fide re~~ a[ the State dFlorida since .
~.,4z~ ,19~~. a~ I reside at ~D luv~ .~,~i-!/E
(StrMt aed Noeb~r)
,ao.°7" ST. LUG I E
cam
and this stateme~ is to be taken as ~ declaration of eitiunship, actual ~ residence and domirrlle is the state d I~7acida.
If fOR THE PURPOSE Of ENROLLING IF FOR NONESTEAO PURPOSES
CHtIOREN IN SCHOO~j PLEASE STATE PLEASE CHECK:
THEIR NANES:
_ _ 1~ MAR -S P#1 ~ 32
~IOtlIT 001N1T
4 `7133'74
I F[JRTHER CEATII~R that I wilt register d mT local address whm the regestrstion books reopen. and oomph with aD
other requirements of a legal resident of this States.
I FUR1~ CERTIFY thst I have no intention to return to m7 former domicile, and I intend to *+*R¦~ is
T u t E Coua~tj.
(Qt~1
Florida. permane~•.
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~F>w<~;; ~ =~'~~eert3ed before me this J` dyli d_ ~ ~Y V T ~ T. ~ ~
=?iS11• _
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` ~.~1~~ ~ . A.D.19~:
ROGER P01 TRAS. CLERK OF G IRCUI T COt~F2T ~R -
ST. LUGIE COUNTY, fLOR1 -
BY:
EPUTY LERK -
g~326