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~~c1ai-ai~on ofi DoR~icile ar~d Ci~iz~nsl~ip /
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S ) 29'73 ~
TO THE CLERK OF THE CIRCUIT COURT,
ST. LUC 1 E ~pU~y, ~,pRIDA:
This is my declaratioa oi Domic7e aad G~tiseaship in the Sta+t,e oi Florida that I am fling this da~ in accordance. and in
conlormit~ a~th Section 222.17. F7orida Statutea. ~
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I v-•as formerl~ a legal resident oi ~A ~~ v"A ~, , ~~W ~n ~~ and j
lCit7) ISeat~)
resided at /\ flJ '_~ ~T"A~v YA L A/V~ . How ever. I bave elsanged my domic7e to
(Street and NamDer)
and am and hhve been a bona fide resideat of the State of F7orida since a ~ day at
f~ [ ~~ C~.S% 19_c] v-andIresideat ~~ Q ~,C%/ ~i~. ~f ~/~Crl / ~~~
l'~ ~ l- ~ J~:~ . cs~ ~a N~~~
ST Ll1C 1 E County,Florida,
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and.this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State of Florida.
" IF FOR THE PURPOSE OF ENROLLING
CHILOREN IN SCHOOL~ PLEASE STATE
THEIR.NAMES:
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1981 J~t~ -9 pN ~: 36
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ST.lUClF CCU::tY.il.p
R~GE R POI i RAc
Ct,EFff Gn"CUIi t_'C(~p*~
F: ^r.:, : i ~ • . l1.~ _ --• -
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5~ 29'~3
I FURTHER CERTTFY thst I v~~7I register at my local address vrhen the registration boo):s reopen, nnd comply witb aD
other requirements of a legal resideat of tbis SLate.
I FIJRTHER CERTIF'Y thst I have no IDLtOt10A to return to my former domie~e. and I intend b remnin in
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Florida, permanenti~.
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IF FOR HOHESTEAD PURPOSES~
PLEASE CHECKt ~
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SR orn to and subsm'bed before me this _ da~ oi r~ /. ~/•
., . -~. ~ ,~.D.. / 98/
RO R P01 TRAS. CLERK OF C I RCUI T COCfir2T
ST. LUG 1 E GOUNTY, FLOR 1 DA -
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BY: ~ .
EPUTY E
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