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Declaration ~
of Dom~ciie and Citizenship z
4'78510
TO THE CLERK OF T8E CIRCUIT OOURT.
ST. LUC i E OOUNt'Y. FLORIDA; .
This is aaT declaration ai Domicile and Cit;senship k the State d Florida tha:: sm i~ thk daT is aeeordanoe. and in
contacrnttT witb section 288.17. Florida Statutes.
I was i me a kcal resident at ~ I •
iQ14I
resided at 8ewerer. I bare eb~anged my domieiM to
IBtrNt aid N~tret
. and am and have been a bona Sde resident atthe state e[Fbrida stone ~ - ~ ~ dq at
19~,~ and I reside at .Q/L.
..LP~t.~ o , ST. LUG 1 E~
caws
and this statemsat k to be eaten as np dedaratioo aE eltiseoship, atetnal kcal :esidenoe and doa~iAs is the state at Florida.
` 1 i FOR TtiE PiiRi*OSE Oi' i:isriv%L f N6 I F FOR HOMESTEAD PURPOSES,
CHILDREN tN SCHOOL,'PLEASE BATE PLEASE CHECK!
~ THEIR NANE8: ~
~ 3~0 i~IR -fi P!~ ~ O7 ~
ti Q~PdTItA~
CLEfiK CNt6'WT C6tMtT
_ tiE'80Rtt VERiFltitl a
i
. ~ IQ
I F'[JRTHEB G~T1F3(that i wiH at mT ioal adde+sss when the ngidratioo books reopea. and ~4 with aA
other sequiraa~eats at a legal resident of thb state.
I FlJRTBFR CERTIFY that I have no intention to ratarn to former and I intend to remain is
_ u tE
fait
Florida. permanenii; .
1
CU
~NT~A ~
• S. ' C~~- ~I I e
~OUNT4.F~'
J,.,
Swora to aad snbxrlbQd befo~+s me this v daT d
. A.D.1~~
ROGER POI?RASL GLERK OF CIRCUIT CO~F2T
ST. LUG i E COUNTY, fLOR 1 OA
BYs - • ~ ` R s
EPIITY LERK '
AGO Form 7l-?Z