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Declaration of Domicile and Citizenship ~~
• ~ S].11'7S
TO THE CI.ERK OF THE CTRCUIT COURT.
ST. LUG 1 E ~p~y, gi,p~w;
~Lit is m,~ dsclaration ~ Domlells and CYti:amhip ia tbe State at Florida tbat I am IDiaa this d~ in aooo~danes. and is
oootormft~ w~itb &etian 2~.17. P'lo~ida Statnt~es.
I wu torme a kgal readeM ol ~ +~ I
, ((aIV) 18taW
resided at However. I have ebaaaed ~ domin'k to
(8t+.rt as~f N~bK1
and am and l~ave been a bona Sde raideat of tbe SW~e of ~7orida ainoe ,/t'1 a y da~ d
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~ ,19 G~. and I reaide at 2 G 30 o So ~. t~. u. S. 1
(8vwc aed Nosb~1
Te» se h ~e_ a c. ~ _ ST. LUC I E ~ti, ~,
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and t~a statement is to be taken as mp declaration d dti:ensbip. aetual kgal reiidenoe and domieDe in tl~e 8tate d Fbeida.
" IF iOR THE PURPOSE Oi ENROLLING Ii POR HOMESTE/10 PURrOSES~
CHII~REN IN SGHOOL~ PLEASE STATE PLEASE CHECKS i
THEIR NAMESS ~
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S ~~ERPOITRA~~.
- CIER!( CIRC(~1 Cp~T~,` -
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5111'75
I FIIRTSER CER1'IFY tbtt I wDl register at q~ locd addres~ when tbe re6idration bod~i rsopea. aad oomp~ witti ali
ctUer rsqmremeaL at a kgal radde~ d tbi~ State.
I P'[JATHER CEft1'IFR t6at I ha~e no intention to retarn to faemer do~oin7e. aod I lotend to remaia in
'~ ~ . Count~.
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F'lorida. permanend,'.
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~~'}~ t1i befare me this ~ dq d
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ROGER P01 TRA$1 C~RK OF C IRCUI T COC~27
ST. lUG I E COUN?Y, fLOR 1 •
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~3~5 P~ 971
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Af,!1 Fnrm 71-?2