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Declaration of Domicile and Citizenship
48i~1
TO THE CLERK OF THE CIRCUIT COURT.
ST. L UC I E COUNTY. FLORIDA:
Tbis is mT declaration d DomieDe sad (~tiseaship is the State d Fbrida that I sm Sling this dq is aoooedanes, and is
oonformit~ with Section 222.17. Florida Statates.
Iwaaforme skgdresideatd lcilldtlda~i:+~ °ii::ucn
and i t
1CR71 ~ lBtrW
resided ~ Ame 1 i a Circle _ _ _ _ However. I have changed mv7 domict~e to
~sd..c..aHo.e.~
sad am aad have bees a bons Sde resident d the State d F7orids since the 2 3rd ~ d
lluaust ,1936 •~I~ed Y8 1020 Grandview Blvd.
. - (8teest na Iiosb~r)
- Ft . Pierce ST. LUG I E ~„ah, Fes,,
tc~l
and this statement is tabs taken as a~ deeLration d dtiaenship. actual legal residence and domia'le in the State d Florida.
- t
_ If FOR THE PURPOSE OP ENROLLING If fOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOI~ PLEASE STATE PLEASE CHECK:
THEIR NAMESS
-t`Iichael D. ~rellstroia
I~0 MAR 31 AM ~ 29
I•Iark D. Itellstr~n
= - ~ ~ TRASA•
. CNtCYR~I~
- R~dA511EttFtEO_____
. 48i?~41
I FURTHER CERTII~'Y that I w~71 register at mT local address when the registration books reopen, and with all
other regniremeats d a legal resident d this 3lste. -
I FiJRTI~R CERTIi''Y that I have no intention to return tom former domiede. and I intend to remain in
4 '
(Qk7) -
Florida. permanenLt; -
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•<<,ainur+gp~
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F~ , Richard B. Hellstrom ~
,r
(Plasd
. ~ : ~ 20 Grandvie 31vd. , Ft . pierce, Fla
Swam to and snbsrn'bed before me this 31 dad d ~ ~ ,
March A.D.18~
6 REPO
I~AS.
CLERK
OF C I RCU 1 T COtdF2T
ST. LUG 1 E COUNTY, f LOR 1 -
•
s
BY: ~ - -
EPUTY t.ERK - y
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~ dt><~~ Pe6E1~
AGO Farm Tl 22
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