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Declaration of Domicile and Citiienship {
X81415
TO THE CLERK OF TAE CIItCUIT OOURT.
ST. LUGIE ~
OOUN'1'Y. FiARIDA:
Thb b np decLration d Domkils and Qkbenship b the State d Fbrida that I am Sling this da,T in aooordana. and in
t~oniormitp with Section 2ZE.17. >!7ocida 8tatutsa.
I was f
~ a heal resident at S T y ~t/~~~/~'1 MA.SS~~'N~/s E7TS I
1441 ititaW
resided at / Sf~ ~ /gam ~r S T 1 Aowever. Thaw changed np domicile t0
18tr~st gad N~Mr)
. end am and haw been a bona Ede reaide~ d the State d Florida sinus .F/ /Zi S % ~ d s
TAit/ i!_~11.... and I reside at 33a S ~ t-3owi T.~ J> > vE", e ~ i ~R d r,~ T ,
cea~..c..a ~
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t/YSt~t/ f?~,~-~,~! ST. LUG i E ~ti, p~~ ~
10141
and this statement is to be taten as mT declaration d tdtbeaship. st:tual legal raddenoe and do®idk in the State d Florida.
If FOR THE PURPOSE Oi ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN sCHOOLs PLEASE STATE PLEASE CHECKS ~ -
~ THEIR NAME82 -
r 190 HtIR ~
- 31 Ph ~2~.
EI~EQ aNC I!:(,4tc~ttU
ST :UCiE COUyi Y.FI A.
ROtaER POITRA5
Ct.ERii CIRCWT CltUR
- R=@QR! VERfFtEtf
481415 ~
I FURTEIER CERTIFlt that I will tsguter at nq itKa] address when the registration boob reopen. and oomplpi with all _
other regninme~s d a legal resided d thb $tate.
I - €
I FUBTAEIt CERTIFS! that I haw no intention to retarn to farmer domk~'ie. anti I intend to nmaia io
u ~ E . CoantT.
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q!e aad ` 4~beribs_d befae+e me thb ~ da,T d ~ .3
. , ~.D. i9t.~LGs.
J -rte, 14A K CIRCUIT Ot~tT
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~ ~ ST.- UC-~ E•COUNTY, fLOR 1
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