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Declaration of Domicile and Citizenshi ~
P
4954'72
TO THE CLERK OF THE CII;CUIT COURT.
ST. LUC 1 E COUIV'1~Y, FIARIDA:
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This is m7 dedaratioa of Domiu'le and Citimnship in the State of Florida~that I am $lin5 thin dq is seoordaace. and in
conformity with Section 2?1.17. Florida Statutes.
E
%P y..y6r TO _ ~/~w ~e ~c d' 6 y and I .4
I was forme a legal resident of 1,-- -
resided at ~ O 3 tiye /9` y ~ _ However. I bave changed m~ domic7e to _
ItltrMt and NamDw)
and am and Gave been a bona fide resident of the State of Florida since ~u ,v G ~ ~ ~ Q dad ~ ~
S'' S~ ~t/il ~
19_~ and I reside at 7 ~ / T.y e ~ ~ 1 ~ .aid t
/ (BtrNt aid Namb~r)
R r S'T' oC yci~ _ ST. LUGIE ~ti.~;~,,
1CIbl
and this statement is to be taken as m~ declaration of eitittnship. actual legal residence and domicDe in the State d Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NANESS
-1980 AUG -7 1~ 11= 51
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Ft``EO AND FEt~I?
~A.
St, `UCIE COINt
CLERK CIRCUIT RA TQ 4
i
RECOROVERIfIEO_ f
_4954'72
I FURTHER CERTIFY that 1 w~11 register at m~ local address when the registration books reopen, and oomph with aD i
other regnirement~ of a legal rrside~ of this State.
I FLJR'1'~R -CERTIFY that I have ao intention to return to my former domicile, and I intend to remain in
J T. t_ u ~ ~ c . Count.
_ ICtt)? _
( 'Florida. permanenu; .
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- ~ _ ? ,
- l,~ _A~w
- D.
AL7"Ei~ I Z 1 y ,
Sworn to and subscribed before me this daT of 7~C''~ f' E k/ ~ / T /y e.c .r D R / ?
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_ A.D.1
ROGER A G ER K 0 G I RGU I T COtdR T
Y
ST. LUG 1 E COUNTY, f LOR 1 ~ -
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5 BY:
EPUTY LERK
OR~~+ ~ ~
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BtIGK ~Jt]V PAGE 87~
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