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Declaration of Domicile and Citizenship
49~'S91
TO TIIE (.ERR OF 1'HE CIItCIJIT OOUAT.
ST. LUG I E ~OZ)NTY. ~,pglpA;
• Tbia b ~ declaration d DomieSs and (btbenabip is tbs. Stets d ><9aeida that I am Slim this dq io aeoordaooe. and in
• ooniarmitT with Section >Zg.1T. Florida Statutes.
I was i~ a bgal seaidsat d ,~~'S~XJ~O~ G _ ~9 and I
tCitT1 t
resided at However. I bays ebaogsd ~ domicils to
i8tiestesdl~ ~
and am and Dave been a bona Sds resident d tbs Stets d Floeida since dad of
19•~~ ana I reside at 7 Fs~
~,t~~l
1en..tedNe>»rt
. ,e ST. LUG 1 E
and thb stabment b to bs taken as aq? dscLratian d dtitensbip. actual legal :esidanoe and domiefls is tbs 8tds d Floeida.
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• IF FOR THE PURPOSE OF ENROLLING IF FOR HONESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK: ~ I'
- THEIR NANESS
,G,,,-- c~ 1980 aUr 27 P~ ~ 0 ~
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~ FILED ANO FECOKOE U
~ ~ S1. UlCIE COU?ITY.F`` A. ~
ROGER POtTRAS
CtERK CIRCUIT COtRtTf~
_ REccan vEPlf:Ct1~-~ ( - E
r
• 49'591
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I FtJItTHER CERTIh'Y that I will register at m7 kinl address when the registration booiu reopen. and with aD '
j ether requuemeate d a legal resident d tbb State. f
I
N I F[1R1'IIER CEATII~R that I bsve no intention to retara to m~ farmer dmnia'le. and I intend to remain in
UCIE
~7.
_ ICit~)
F'iorida. permanenci; .
,'o`rs
~ /6 ~
• Sworn to and snbeeibed befa:e me this °Z 7 day d
.~.n.1~_igN%ce L. ~U ~ lliAMs
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ROGER PO1'RtAS. CLERK OF CIRCUIT CO~ItT
ST. LUGIE COUNTY, FLORIDA ~ -
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EPUTY LERK ~
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80011 (P~~
.
AGO Form 7]-2Y ~
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