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Declaration of Domicile and citizenship ~'
509450
TO THE (~.ERK OF THE CIItCUIT OOURT.
ST. LUG 1 E apv~y, ~,p~A;
Ti3s b mT deeLration d Domicitie and Cltisensbip in the State d Floocida that I am >~ this dq is accordance. and is
eontarmitT with Section 228.17. Fbrida 8taWtes.
I was f ~ a legal:'esided d ~~,~y, ~ ,~~~~ - _~ and I
resided u ~~~s~~'~ ~-~-~ iC~41 n- ,e~~ ~
,. ~ o . ~ T1/ .0~,6~- ~~ _ However. I have domieitis to
ttw..c.ea~~e.~
and am aad ha~vye- been a bona Ede resided d the State d Florida since .1~ . S- ~ ~ dq d
/~ .s .19~ and I reside at ~1~----- -- -- ~. - ~"
t8t+~e~ ~ H
ST. LUG I E ~, Fes,,
«~s~
and this statement i. to be taken as mT dee4ration d citisenship. actual legal reaidencs end domidle in the State d Placida.
IF FOR THE PURPOSE OF ENROLLING
CHILDREN IN SCHOOL, PLEASE STATE
THEIR NAMES:
O ~- v
IF FOR HOMESTEAD PURP08ES,
PLEASE CHECK:
X80 QEC -5 PM 12~ 58 `
FILED ANC F!'COROEO
ST.LUCIE COUNTY.fLA.
ROGER POITRAS
CLERK CUtCiNT COURT
SC-9450
I FURTHER CERTII~'Y that I will register at ~ local address when the registration boots reopea. and eomplT with aII
other regttirements d a legal resideat d this State.
I FURTHER CERTIFY that I Gave no intention to return to farmer domie7e, aad I intend to remain is
U C I E . CST.
ICS)
Florida. permanentl;
~ N ~ s
U - ~` G ]~ ~
:~ ...
Sworn to and subsQibed before ms this -5 dad d
ROGER P01 TRAS. CLERK OF G IRGUI T COt~2T
ST. LUG 1 E COUNTY, fLOR 1 WI
• .,
_ EPUTY JERK
~34~ P,~1~3
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AGO Form 7l -71