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Declaration of Domicile and Cit~zensh~p
4'~962~1
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E COUNTY. FLORIDA:
This is m7 declaration of Domin'le and Citisenship in the State of Fbrida that I am Sting this d~ in sooordanoa, and in
eonlormit~ with Seetion 222.17. Florida Stagtea.
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I was fob a legal resident of ,~{t~~,(1F,PiS/I,CL ~
~~CQ,. ~ I
lCit71 113tat~)
resided at ~ ~ ^ However. I have changed mp domic0e to
18w~t sad umbw)
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and am and have been a bona Sde resident of the State of Fbrida since ~ daT of
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-19~~ and I reside at Q'y~ C,L-' c%~' ~B.G
18trsat and Hombet)
i>~.-~' T" /l ~ ST. LUC I E CountT. Florida.
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and this statement is to be taken as my declarstion of eitiunship. actual legal residence and dome in the State of Florida.
_ 1~ FOR THE PURPOSE OP ENROLt.ING It! fOR HONESTEAO PURPOSESs
CHIt.OREN !N SCHOOLS PLEASE STATE PLEASE CHECK:
THEIR NAMES:
1980 MAR i 7 Aid ilk 04
u.~ ~ a<E o>RU~:u
~ti>ac~'+~tY r~A.p
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• 4'~96Z1
I FURTHER CERTIFY that I wIIl register at m~ Loral address when the registration books reopen, and complJ with all
other requirements of a legal rtaideat of this State.
I FUR173ER CERTIFY that I have no intention to return tom former domic~7e. and I intend to remain in
U C ! E • , Count.
ICitr! -
Florida. permauen~.l; .
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Y,.
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Swd1$I li~'~'subsen'bed before me this ~ daT of % ' ,=~/(/~.C~i`~~! ,
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T-C~n . A.D. I9~. ~
. ~~huc ~ ~ ~Gc1E?i~r~~
R AS C ERK OF C IRCUI T COC~tT
ST. IUCiE COUNTY, FL 10A
BY:\ C c
EPUTY LERK
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