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Declaration of Domicile and Citizenship
/-
S].03'79
TO THE CLERR OF THE CIRCUIT OOURT.
ST. LUC i E ppv~y. ~,p~A;
TWs is m7 deelaration d DomicDe sad (~tisemhip iv the State d Florida flat I am Slioa this da,7 in acoordanee. and is
conformit7 with Section 222.17.1`'lorida 8tatutp. r - /
I was farme~rj a legal resident d ~G ~ rV ~ ~ ~ • y ~ and I
_ i~~ 18t.t.1
resided at
R ~ /~C
However. I have changed ~ domia7e to
l8tr~tt ~ Nss~bsr)
and am and have been a bona Ede resident d the State dFlorida since ~ 5 ~ dad d
J~ N T .1S a te. and I reside at ~1~ ~~ V W h/ C
~ 0 /ZT~ ~/ F t2 C ~ ST. LUG I Eew.c..dN~e.rl
. Count. Florida.
tCtgl
and this statement is to bs taken as mT declaration d eitirenship. actual legal residence and domiccile is the State d Florida.
IF FOR THE PURPOSE Oi ENROLLING
CHILDREN IN SCHOOL, PLEASE STATE
THEIR NAMESS
r-
IF FOR HOMESTEAD PURPOSES,
PLEASE CHECK:
1980 OEC 12 PM 2~ O1
FtLLEO1-Mf ~ECORDFD
ST.LUCIE COUNTY.FLA.
ROGER POITRAS~
CLERK CIRCUti CO
S)_(13'~9
I FIlR1'HER CERTiFR that I will register at 4 krcal address when the registration books reopen, and eomplT with all
other r+egniremeats d a legal r+eaiden< d this State.
I F'(1RTAER CERTIFY that I have no intention to return to mT farmer domin'k. and I intend to remain in
. t_ uc ~ E . ~~.
tGt~l
~7orida, permanenci; .
:1` ~ i
.r. .\:..~ :,..
K: ..r. i,
s~ ~ ~.,~-f : .
•' •.s F~,
...~;;~~
Sworn to and enbsQibed before me this ~ L ds~ d
~ 3 C'' I2 0 y~ ~-~/ ~ l
u-dar...)
R P01 TRAS. CLERK OF C IRGUI T COC~2T
ST. LUG 1 E COUNTY, FLOR 1 OA
• 1 ~
BY:
EPUTY LERK .
C~o u ~ S ~ Qkc1~c~)
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• ~ , ,
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e~ ~A
AG!1 Form 71 ?2 ~