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Declaration of Domicile and Citizenship.
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. 4'78566 ~
TO Tl~ CLERH OF THE CIIii.RJiT COURT.
ST. LUG 1 E apv~, ~,0~~
This h mT dsdaratioa e[ Domieife and Clthenship m the 8tats of lo'locids that I am Q~.lbh dp ie aeeosdana. sad ie
oo~atecaoitT wlth Seetioa >"3t.1T. Fkrida Statutes. .
I was i r a {esa! raideot d s y S S e)( y /l~c to Trrs c y and I
ICttl?1 f8t~1 T`
reidsd ac _ _ ~~d (SID % lA~e / .9~/.P. ~i/ .~oA 8awwer.I bare ehanpd mpr doodeDs to
roti..c..d~..~
. sad am and have bees a bona Sds reaideat at the State d Fbcida loos f # ~ f rS ~ dq at
/'I'I /9r'C ~ .19~~ and I:+sside at 0?l5~/ /~Pt.~ S/o ~ /~C s~rp pT
/Po.-T .~T Ly~~ ST. LUGIE~~N~
- tdbl Coast,. Fkrids.
end thh stateaiest h to be tales as ap deeLsatios e[ dtisenshiP. aetaal kcal residssoe asd domicile is the State d 1!7orida.
. IF fOR THE PURPOSE OP ENROllIN6 If ~OR NONESTEAD PURPOSES,
CN i ~OREN 1 N SCNOOI., PLEASE STATE I~~E~liE CHECK!
~ TNEIR NAMESS / 1 '
s~/17ue1 ~hr,`S/r9~y /nor ' .
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!f SO~V t f7 /~e~ C~ ro.y ~~~Ay~ o?d) ~ A R p
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~TER~O
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I b'tJBTI~t (TEITIItYfl~1 w~ reShter at aq bail adde+eee i~hes the rsaMtstios boob scopes, and ooa~ wits aII
atber requirsmemts d s kaaJ d thh State.
I FiTI;TIIER CEItTII~'Y that I have ao Mention to return to m7 former domie3le, sad I intend to temais is
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Florida, permaaent~;.
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S•.oes to and subscribed before me thh ~ daT at ~i-t~ ~ o~
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gOGER PO I TRAS,~ CLERK OF G i RGU I T CO~tT
ST. LUC I E COUNTY, fLOR 1 OVA
BYs
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EPUTY LERK
80~ Parr
AGO Ferro 71 _?2