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Declaration of Domicile and Citizenship
S~.nb'73
TO THE CLERK OF THE CIRCUIT OOURT.
ST . L UC I E ~pUNTY. FL~ORIDA:
This is m~ decLration oi Doauu7e aad G~tize~uhip in the State ot Florida that I am IDing this da~ in aeeordmee. and in
cor-formity w-itb Section 222.17. Florida Statutes.
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I ~ras formerl~ a kgal resident ~ / 1 v!4 ~'!t .q
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resided at ~ U~ /~ (~'r /~U// TI'A iL
(St:s~t aod Namb~t)
aad am snd 6ave been a bons Sde resideal of the State oi Florida ainoe
I~ ,Jr ~~ ~ - 1~ ~/ aad I reside at ! Jq~~ .n
~
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r r~~ f,~~,~- , s-r. LUG I E Count~. ~..
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aad this statement is to be taken as m~ dcelaration oi citizenslup. actual kgal residenoe and domie~7e In the 3tate ai Fiorida.
- IF fOR THE PURPOSE OF ENROILiNG
GHILDREN IN SCHOOL~ PIEASE STATE
THEIR NAMESS
ayo 6
~0 DE~ 16 ~t ~ 2 ~
FIl.EO AI~ FECQRDEO
SL Ll~i[ COUl1 f Y. FL A.
C RK C RCUlT CAURT
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S~.(1b'73
I FURTHEA CERTIFY tLat I w~l register at m~ local address when tbe registration books reopen. and eompl~ with a11
other reqnirements ot a kgal resident of t6is State.
I FLTRTHER CERTII~'Y ~hat I have no intention to return to m former domiei7e. and I intend to remain in
~ ~ , ~ U C 1 E , Count~.
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Florida. permanenti; .
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flowever. I bave c6angod m,y domieile to
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lBtrMt ~sd NnmbRl
IF iOR HOMESTEAD PURPOS~Si
P~EASE CHECK: ` ~
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ROGER RQITRAS* CLERK OF CIRCUIT COC~tT
ST. LIJG 1 E COUNTY, f ~OR i OA
BY: ~~~~
_ bEPUTY ~~eRK
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