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Declaration of Domicile. and Citizenship
TO TH>; cx.ERlc of Tim c>Ilcurr oovRT. 4bi1996
ST. LUC 1 E OOUN'PY. FLORIDA: ,
Tbb is mT dsc4ration at Doaokile and (~tisenebip b tbs State et Fkrida that I am filing this daT in aooordanos. and m
oonfaemltT with Section ffi2.1T. Z'9arida StattKas.
I was fr a kEal resident d ~ a9a ~ _ ~ and I
10141
resided at ~ ~ l~~ 2- - Howevet.'a bate eballged nq domir~e to
atl Nei
. and am and have been a bans fide resident of tbs State dFloeids sins ~ ~ dq of
i9 oy ' and i reside at t~0• - '
18tiwt W
~lt7" ~,~o,p~. ST. lUC 1 E
ti7ldl
and this statement fs to be fates as ap declaration at dti:ena6ip. adaal Isgal residence and domicile in the State d li7oiida.
If fOR THE PURPOSE OF ENRO~I.ING IF iOR HONESTEAO PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK!
~ THEIR NAMESL _
.7 ~
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X980 AFR =7 ~!I I~ 02
~I~t?GE11 POITRA~ ~
~Hltt(CIRGIIT COlN1T
!~M VFICIFIED_
I FIJRTI~R CERTII~'Y that I will register at m41oca1 addeeis when tbb regbtration boob reopen. and eoeapb with all
other regmcements of a legal resident at this State.
I FURTIIEit CERTIFY that I have no intention to return tom farmer and I intend to remain in
_ U 1 E ~ ~7.
1A41 _
Fbrida. permanents'. .
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sworn to and snbseriibed before me this daF d - ~a
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R A ~ ERK OF' C RCUI T Ot~'2T
9 ST. 1 E G4UNTY, f LOR 1,
8Ys ,
E PUTY t.ERK
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