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' Domicile red Citizenshi - ~ .
Declaration of a p
82538
TO THE CLERK OF THE CIRCUIT COURT, 4
ST. LUG 1 E COUNTY, FLORIDA:
This is my declaration of Domidls and Citizenship in the $tats of Florida tbat I am filing this day in accordance, and in
conformity with Section 222.17. Florida Statutes.
I was former a legal resident of ~:%YG~"i..7Z/YIrJ,~t~- C> and I
lCtt71 t~l
resided at ~ However. I have changed rep domia'le to
(ea..c..a Noabw? !
• and am and have been a bona 5de resident of the State of Fbrida since ~S day of -
-t1...---.19~~, and beside at ~ D ~ -~~~%1 L~iG-~E' , -
.-~Z~ (BtrNt sud NamD~rl
_~~~.-r ST . L UG I E ~ti, Via,
tabs
and this a4tement is to be taten as my declaration of citizenship. actual Legal residence and domicile in the 3tats at Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL,. PLEASE STATE PLEASE CHECK:
THEIR N NES: -
. ~ /
,:y;
" - ~ ~ 1960 APR 10 11M t1= O
_
r E~ C~~A L,,. a
_ - Inc c~cw!'Olt tGORSS
vE~~o r
- t~82538
I FURTHER CERTIFY that I wi71 register at my local address when tbe registration booiu reopen, and comply with aU
other requirements oI a legal resident of this State.
~ I FURTHER CERTfF'Y that I have no intention to return to my former domic~e, and I intend to remain in
- - _ ~ ~ . ~ v ~ ~ ~ .County.
((~c7)
t -
! Florida, permaaenti; .
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- Sworn to and snbsen'bed before me this ~ ~ day of ---1 _ ~ • J -e--- • e.-
o •
ROGER P01 TRAS. CLERK OF CIRCUIT CO~FtT _
ST. LUGIE COUNTY, FLORIDA - -
• ,
EPUTY I.ERK ~ -
- 1
8(.bK~~7 PAGE 4~ ~ _ . •