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Deciarat~on of Domicile and C~t~zenship ~4
495259
TO TSE CLERK OF Tl~ CIItCUIT OOURT.
ST. LUC 1 E OpU~. FZ,p~A: `
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This is ap deelaratioo oI Domicda and Citisanahip is the State of Florida that I am IDioa this day in acooe+danoe, and iD
oonfarmity with SeCtioO X2.1?. Florrida Statutes.
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I was fo~ a kgal resident of Vi I7 a /C!/~ c/ _ C/' aawl I
1G41 18t~_~~~ !
resided at / t'i l S/ ~~/DO d P .'~-1 r- 7.~' _ fio~.e~s. I anus chaaaea~m,/y domic7e to _
1&rwt aMNaMr)
and am and haw been a bona fide resided oltha State o[Florida ainee f'~ ~ day at
IO~ and I reside at I ~ a N ~ ~o b.S7`~ r /1 c~ ~
18tr+~ ssd HasiD~rl
~n r7?- r. L ~c~'G _ ST. LUG I E county. Fle~iaa.
ICltyl
and this statement is to be taten as my deeLratioa of eiti:enship. acttial kgal reaidenee and do®ia7e is the State d Florida.
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If fOR THE PURPOSE Of ENROt.~ING If FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK: ~ ~
THEIR NAMES: ~
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I FURTHER CERTII~'Y that I w~11 register at my local address when the registration boobs reopen. and damply with all
other requirements of a kgal resided ad this State.
I F'ITRTT~R ~ CERTIFY that I have no intention to return tom former domie0e. and I intend to remain in
~ _ U__C 1 E County.
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Florida. permanents; .
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ST~L ~ A BRA.
E CLERK CIRCUIt COURT
RECGRO YERiF1ED-_
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. Kpd snbxra'bed before me this day of 335
w.n. is~Q
~ R ER PO A C ER K OF G I RCU I T COt~t T
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ST. LUG 1 E COUNTY, FLOR t OA - ~
BY: -
. v r t.ERK
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~Gn Form it 71
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