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Declaration of Domicile and Citizenship
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TO TAE CLERK OF THE CIRCUIT COURT.
ST. LUG I E CpU~y, FI,O~A;
This b m, deeLration d DomkiM and Citissaship is the 8tats d 1:7orida that I am ifling this dq is aeooedana. and in
cwiformitT with Section 288.17. Florida Statutes. , 1 -
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I was iorm a legal resident d ~ n ?~Y l) ~ ~ ~ P , and I
~ tav~ ~ re~w
resided at ~ • r ; ~ 'b~~ - Sowever. I have changed ~ domldl. to
~e a.aAl..l.rl
. and am and have been a boas Bds resident dtbe State dFlo:ida since - dq ei
Ck ~2 C ~ ~ .18 r, U - and i reside at ~ l~_~I l1n't { ~ ~ ~ 1 1/-C~ P
Tieer..~..a
~r . ~ y t ~ ST, lUG 1 E Coa~.li7aida..
tavi
and this swement i. to be taken as nq dsdarat3on d dtisenship. actual legal reaidsnae and domidle is the Stag d Florida.
, ~ I F FOR THE PURPOSE Of ENROLL 1 NQ ~ ~ •I F fOR~ NOMESTEAD PURPOS S,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CNECK!
~ THEIR NAMESS
Ja m~ ill. I,~~r ~ ah~t'
4t~2A26
_ 1980 APR -7 PM i~ 4S
FiLEO ANC ~EC01~L~1•Q
ST.lUC1E COU:ITY.FIA.
" iLERK C!!!CUIT COURt
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I F[JRTHER CERTIFY that I wID rsguter at ~ local address when the registration hooka reopen. and compb with all
k other regainmeats d a legal resided d this State.
I F[JRTAER CERTIFY that I have no intention to retmn to former domie3b. and I intend to remain in
1 E . Connt7.
(Cttjl ~
1!7onda, permanend, . r
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"
couNjy
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~ Swam t0 and before methis dy of
i ~
. A.D. i~; S~ eRR~/ a`TT~R SaN .
E
ROGER POI TRAS. CLERK OF CIRCUIT COIdtT
ST. LUGIE COUNTY, ftOR10A
EIUTY t.ERK •
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