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Declaration . of Domicile and Citizenship
4sz~8s
TO TAE CLERR OF THE CIRCUIT OOURT,
ST. LUG i E apv~y, ~,O~A;
This b m7 declaration of Domicde and Citizenship in the State of Florida that I am ~d thL da,T is aooordanee. and is
oonformit~ with Section 222.1T, Florida Statutes.
I was f rmer a legal reaident of ~ ~'~S GD~?Si h ~ I t
tc~c>> csaw ~
resided at 30~? ~ y l/~ ~ Li S j Aowever. I have changed mT domidle to ~
t8terat and Nmbar)
and am and have been a bona 5de resident of the State of Florida since ~ dq oI
_ /9 ~l'/ ~ L. _.19-~
v • and I reside at _ -3~ ~ L1~5 ~ifi ~ ~ .
l8wat aad Nnmbrl
~or/ S 1~ G ~ c,i
~ y ST. LUG I E Count, Florida.
It~b)
and this statement is to be taken as m7 decLntion at citizenship. actual legal residence and domicile in the State d Florida.
IF FOR THE PURPOSE O~ ENROI.t.ING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR. NAMESS
_D~r~~~ Lee GPr~~i~ n
_ 1980 APR i ! Ply 3 2i
it o,?w 1~~Y` ~
al~a~~~""' {
arc t
aerl~r~'teo
~4~2'786
I FURTHER CERTIFY that I wt~l register at mT local address when the registration books reopen. and oomplT with all
other requirements ad a legal resident of this State. ;
I FURTHER CERTIFY that I have na intention to return tom former domicile. and I intend to remain in
U 1 E , Cou~T.
s~ sI Esc. ~ tcse>>
Florida. permanencl; .
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Sworn to and subern'bed before me ties daT of . _ ~ a~t,ccc,(,
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A.D. ls_~_Q_+ lZ ~ • GQ R II a R ~l
ROGER POI TRAS. CLERK OF G IRGUI T COt~dRT
ST. LUC i E COUNTY, f LOR 1 OA
_ BY: ~ ~
~.c U~(.c .J ~
. EPUTY LERK '
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