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Deciaration of Domicile and Citizenship
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TO THE GZ.ERR OF THE CIItCU1T OOURT.
ST. LUG 1 E ~pU~y. ~,pg~w;
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Thts is m~ dseLration oi Domicile and G~tise~ In tbe State ot Florida thd I am 51ina tbis da,~ ia aaoordaaas. and in
oonta~nit~ wlt6 Seetion 2?Z.1T. Florida Statutes.
I was !~r a legal reside~ at -~ *~; ~ t,; -~,-~n and I
_ 1 18taW
~ u, 3^ 9? T~ ~ i t e'' i r c h D r. Aowever, I Dave ehanged m~ domoidk to
18tn~t ~od N~b~
sad am ae~d Dave beea a bona 6de:eaideat at tbe Stat~s ot Florida aiaoe,:,;~,~ •~g~~~ lq.;• o ,:.~:~y d~ d
nctoher 19 79 ~I~e~ ;O~ 'Iaple Terrace
(8h+~t aea Nomb~
"orth '_=ort St.Lt.cie ST. LUGIE
cav~ , ~i. ~o~taa.
and t6is statement is to be taken as ~ deelaration ai utirenship. actual legal residenee and domide in tbe 8w,s ot F'laiids.
" If iOR TNE PURPOSE OP ENROLLING
CHII~REN IN SCHOO<i PLEASE STATE
THEIR NAMESt
~
IP iOR MOMESTEAD PURPOSES~
P~EASE CHECKS ~
1980 DEC 18 PN ~ 04
FIIEC RkC FECOF.UfO
Si.tUClf COUN1Y.flA.
ROGER POITRAS
CIERK CIF.CUIT COURi /'
~~Cb~f, ~iP'.~t( _ ~I__
5i~.06~
I FUATHEl; (~T~ tbat I wtp reg~ster at nq loeal address when the regi~ration booirs reopea, aad eomp~ wltb ail
otber reqm~ements d a kgal reaideat ot this State.
I F~JATHER (~A'1TE'Y tba! I bave no inte~tiao to ntmn to lormer domin'k. aad I int~ead to nmain io
~ UCIE
_ , . __ ~~~ .~ Count7.
F7orida. permaneatl;.
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Sworn to aad wb~eribed befcrs me t~ ~ g daj at -
.
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R4GER P01712AS. CLERK OF CIRCUIT CO[~2T
C~t R/ ST e nt S 0 ~Y
ST. LUGIE COUNTY, FLORIOA - _ .
.. - ,
- • .~„
- - BY: ~ : .a
EPUTY LERK '
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