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Declaration of Domicile and Citizenship
495261 ~
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TO THE CLERK OF TAE CII~CUIT OOURT.
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ST. LUC 1 E OOUNTY, FLORIDA:
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This is ~ declaration of DomieiM and Citisenship in the State of Fbsida that I am this dq is aooo~danoe. and is
conformitj with Section 2?2.1T. Florida Statutes.
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I was f ~ a legal resident of - _
(Ck7) 1&w)
resided at ~ C 1 ?Vl ~Yl 1 T 1~
~ . - However. I ha~n ebanaed m~ domia7e to _
t8trrtt aad NooDw) `
and am and have been a bona fide resided of the State et Fbrida since ~ ~ ~
l ~ 19=.~ and I reside at r o ~ ~ ~ ~ / S TC~ I~1 ~ ~CJ~:
(SteMt aed Na®b+d t
j ST . LUG I E Count. Florida.
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and this statement is to be taken as ml declaration at eiti:enship, aetnal legal rsaidenoe and domieDs in the Stets of Florida.
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1 f FOR THE PURPOSE Of ENROLL 1NG 1 f fOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
- h7oY AU6 •s M ~ 32
ti
495261
I FURTHER CERT'IF'Y that I w~71 register at m~ local address wben the registration books reopen. and wmpl7 with all
other requirements od a legd resident o[ this State.
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I FURT'SER CERTIFY that I have m inte~ion to return to m~ farmer domicile. and I -intend_ to remain in
_ (City) _ 1
f Florida. permanensi; .
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Sworn to and anbsa~'bed before me this T dy of ~ ~7 / ~ L:~l~ '
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A.D. l~f. -
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_ ROGER P01 TRAS, CLERK OF C I RCU 1 T COfdtT
ST. LUGIE COUNTY, FLORtOA ~ -
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BY: ~ ~
_ _ EPUTY LERK ii
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~ C;!1 Form 71 ?2
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