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Declaration of Domicile and Citizenship
4'432
TO THE CLERK OF THE CIRCUIT COURT.
ST. lUC I E ~ WUNTY. FLORIDA;
This is m7 declaration d Domicile and Citisenship in tbs State of F7arida that I am ~ this dq in aoooedaaoe. and in
confornaitT with Section 282.17. Florida Statutes.
I was f r ae a bgal resident at ~o S o e (~1~.1 _ ~TA ~ and I
lCk~l t8tate!
resided at 115(0 i.A IU? I~ ~ i2A _ Ho..ever. I have changed np domin'le to
tea..esaNose.rl
aad am and have been a bona fide reagent at the State of Florida since ~ 02~ ~ ~
/-IUC~US''~ -19~~.andIresideat 104 lr P~~A V~srA B~?D
tea..c..aN..e.rl
Po~T S'r ~y`r~ ST. LUG I E - Connti.
tabs
and this statement is to be taken as mT declaration ai eitisenship, actual legal residenoa a~ domia'le in the State at >F'beida.
IF IOR T!!E PURPOSE Of EMRO!!!NG IP fOR HOMESTEAD PURPOSESs
CNIlOREN IN SCHOOL, PLEASE STATE PLEASE CNECK2
THEIR NAMESt
- /~1 o.urc A ~1 EZA
/~I1C f-1AE[., ,r~EzA 49'432
- 1980 AUG 26 PM Z~ 17
` f11E0 A pF~Eq~1CORDEO
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R06~~ W Cis A.
aElac ciacw
aECOac? ~~EaiF~rr.
i I FURTHI'~i CER1'IFIf that I w01 register at mT local address when the registration bodes reopen. and oomph with ail
i other rcQninments at a kgat resident of this State.
~ I FURTHER CERTIFY that I have no intention to return tom former domie7e. and I intend to remain in
U C 1 E ~ County.
_ (abi
Fbrida. permanend; .
J`
r ~ j ~ J%{•
. ~ .;~lvc,, (tom)
~ ~G~[;i`!~c~
i/1d~
Sworn to and snbeerIbed before me this °Z 6 dsj of
ROGER POITRASr GLERK OF CIRGUI T C0~2T -
ST. LUGIE COUNTY, ftOR10A -
~1/
- EPUTY~ JERK ,
_ g~~K~37 Pa~E1067 • -
AGO Form 7~-22