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Declaration of Domicile and Citizenship
TO THE CLERK OF THE CDtCUIT COURT.
ST. LUC I E CpU~Y, ~,p~A; .
SUl982S
This b aq7 declaration os Damieile and (~tisensbip in the State et Fbeida that I am tiliag this da,7 io aooordanos. and in
ooaformitT with 8eetion 222.17. T'7orida Statutes.
I was t~ a kdal resident of ST GGA//2 S~• ,/~/~i~~~oA~/ and I
~O n ~/ l(*7) 18tata)
eesided at °'z ~ ~~~ ^' /7/ ~~~~ ---- _ Ae~arer_ I have ebanewd m~ demid)e to
18t~wt ud
and am and have been a bona fide rssids~ e[ths State otFlorida ainoe ~~~ ~ daT of
19~ ~ . and I reside st ~ ~oZ ~ .s. ~. Gl//S/~i~~~~•F ~1,.
18trwt ~ NobK)
PO~E'7` S7:' G yC~i,~ ST. LUG I E ~.~~
Isar -
and this stateme~ i. to be taken as >~ declaration of eitissnship. adnal legal residence and domieDe is the State of >:7orida.
" IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMESS -
LOUIS ~, cE~ev~ ~ 1
1980 DEC - I PSI 12 39
ST L ~~~~~ii A.
OLEfiK
CNICIIRT
A69oAD \'ERIFIEO
a)QC7C7~S
I FURTHER CERTIFYY that I will register st m~ local addrass when the registration books reopen, and ~P17 with aU
other ngniremenb as a igal resident of this State.
I FURTHER CERTIFY flat I have m intention to return tom former domicile. and I intend to remain in
-- - U 1 E . Countj.
)p~~) _
Florida. permanents; .
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Sworn to and snbeeribed before me this ~ ~ dad of
- A.D.1
., ~.~ 4.
N ~c~('
viTA MRRi~} C'e 2u Ili
ROGER POI TRAS. CLERK OF CIRCUIT COCd2T
ST. LUG I E COUNTY, f LOR 1 OA
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- ~ X344 P~ 49 - i._ ~ `'
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AGO Form 71-~
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