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Declaration of Domicile and Citizenship
4t~390bi
TO THE CLERK OF THE CIRCUIT COURT.
ST . LUG 1 E .COUNTY, FLORIDA:
This is a4T declaration of Domicile and Citisenahip In tbs State of Florida that I am Ring this day in aceordanoe, and in
oonioiadty with Section 222.17. Florida Statutes.
I was tormerli a legal resident of ~ _ and I _
_ 71 - (Scats)
resided at ~ However. I have changed nqy domiet7e to
(8tewt sad Nas~baN
and am and have been : bona Sde resident of the State of Florida since ~i_ ~ day ~
IS~.. and I reside at ~ ~ / ~r~[P~- ~c-'Pty ~ -
• IStra~at sad aaabw)
-t ~ Q,~, ,r ST . l UG 1 E County. Florida.
tGbl -
and this statement is to be taken as my declaration of citizenship. actual legal nsidenoe and domicile in the State a[ Flacids.
I IF FOR THE PURPOSE OF ENROLItNG IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NANESS
a~39as
1980 APR 22 i 17
tE0 tND FE 0
S~ L to Y. LA.
PgTRA&
~t3K t211011R CQfptT
+.rc~^sYfe~~o- • ~1J .
I FURTHER CERTIFY that I will register at my local address when the registration books e+eopen. and comply with all
other requirements of a legal resident of this State.
I FL1R1TiER CERTIFY clot I have no intention to return tom former domicile. and I iatend to remain in
U C 1 E ~ County,
- caty~
Florida. permanensl; . - .
' ~ ' ° - qtr. /
~x - _ Pace ~ (Haase)
Sworn to and snbser,'bed before me this ~ day of ~ ~
. . A.D.19~ -
. ,J,~M ~ 5 -1- NJ ~E S"
ROGER POITRAS. CLERK OF CIRCUIT COCdZT
ST. LUGIE COUNTY, FLORtOA ~ -
. EPUTY LERK
~n~X~~ YtGE~V'tl _ i"-~-