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Declaraiion of Dor~icit~ and Ci~i~~ns~~i~ -
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~ 513.322
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG I E ~p~y, ~,pRID~; '
This is m~ deelaration oi Domic~e and G~tizeaship in the State of Fiorida that I am filing this da~ in accordanoe, and in
conformit~ with Section 222.17. F7orida StatuLes. ~
' O
I R as iormerl~ a 1egu1 resident oi ~ i
' . ~~~..~ lCie~) Isw,s1
resided at I ~~p~ '77. ~~~ Ao~ever. I 6ave changed m~ domic~e to
(St~eet and N~ber) ~
and am and have been a bona fide resident of tbe State oi Florida since ~~ f~ ~ da~ oi
i
~• ,19~ ~ , and I reside at .~ 7 G/ S~ ~/ ~ r°~ l~ l3 ~ t~ ~
(St•eet aad Neaber)
~~~ 1; v C ~ ~c. - _ ST. L UC I E Count~. Florida,
~~~
and this statement is to be taken as my declaratioa of atizenship. actual legal residence and domica7e ie tbe SLate of Florida.
" IF iOR THE PURPOSE OF ENROLLING
CHILDREN IN SCHOOL~ PLEASE STATE
THE IR NAMESS
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IF FOR HOMESTEAD'PURPOSES~~-
P~EASE CHECK: ~
1981 JAN I 3 At~ I I= 12
fIlEO ~NC ~ECOR.9f[t
5 RGGER f~01TRASA
CLERK ClRLUtT COUR .Q
Q~cr,~r. Ls--:~ ~~. ~ ~ `- -
513322
I FURTHEB CERTTFY that I w~11 register at my local address when the registration books reopen, and comply witb aD
other requirements of a 1egaJ resident of this State.
I FURTHER CERTII~'Y that I have no inteation to return to m~ tormer domiu7e, and I intend to remain in
~~---- .JT * LUC i E _~~ty,
1(St~) .
Florids, permanenu~.
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Sworn to and snbscn'bed before me this ~ 3~ ds~ of ,~ ~~~
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ROGE PO I TRAS, CLERK OF' G I RCUI T COCdi2T , .
ST. LUG I E COUNTY, FLOR 1 OA •
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BY:
~ _ EPUTY ~ERK
800~ ~~~ Pd6E l~o
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