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Declaration of Domicile and Citizenshi
505817
Tt3 THE CLERK OF THE CIRCUIT OOURT. .
ST. LUG I E apv~•y, ~,p~p~.
- This is m7 declaration of Domicile sad Citisenship is the State aJ Florida that I am IDing this dal is acoordaaoe. and is
- eoatormitT with Section 222.17. Fiosida Statutes.
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I was i~ a legal resident of - Thb/~1ASUll~L _ _ (j~/~'~S //9 and I ~
(Qit~) l8tat~)
resided at _ ~.3 9 ~ /QSON ST . How.ver. I have cbaagea mT daa~ne to
18ttMt red Ns*b~N
and am sad have been a bass 5de r+ssideat ottbe State otF7orida since / 7 ~ 7g - ~ ~
1~~
9_, and I reside at ~ / ~ ~l X~E 1 ~
18er..c ~sd Nobr)
~7. ~IF~(',F ~ ST. LUC I E
t~ Counti.I+lalda.
and this statement is to be takes as sq deelaratiaa of dtiasnsbip. adnal legal residence and domicile is t>te State d l7oeida.
" IF FOR THE PURPOSE OP ENROLLING IF FOR HOMESTEAD PURPOSES,
CNILOREN IN SCHOOL, PLEASE STATE PLEASE CNECK: ~ -
THEIR NAMES:
- f~ - :a
. 50581'7 ~
- ~
I FUR1'IIER CER1~Y that I wID register at mT foal address when the registration books reopen. sad eompb with aD .
other regniraments of a iega! resident a[ this State.
I
~ I FtJTtTIIEK GER:~'Y that I have no iatzntion to return to farmer domia'!e. sad I iatead to remain is
:ac3) t • ConntT. ~
Flonda. permaaentl; .
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~ G IRGUI T COCd2T
ST. LUGIE COUNTY, f~OR
'
- ~ BY: -
EPUTY LERK
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' X42 P~ 578 ~ .
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