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Deciaration of Domicile and Citizenship ~
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515580
TO THE CI.ERK OF THE CD~CUIT~COURT.
ST. LUG 1 E apv~y. ~,p~w;
• wea~e
. This is m~ deeLntioo a[ Domic~e aad GYtisensLip in tbe Stale ot Fbrida tbat i~a ~in` thia dq in aooo,rdanoe. and b
ocaformit~ ~vit6 Section 222.17. Florida Statutes. ~
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,i+.~r former~ a legai nsideot at ~~ R R ET T PAPK M~4 fz ~l- ~-J D ~ y
1~1 yJt ~~ au~`
n~~ u 4~ I q C A ~n (3 RI A Qv E Nt~ E go~vQVer~ ~6ave eban~ed a~}domieDe b
lStrat aad N~bN -
and~ and bave been a bona Sde re~ident atthe State oi Florida sinoe ~'h'G ~ W e~'1 ~U --E-h i rd a,,,~ d
~an~aru ~s B~ .~-na~~aeu ~a~ S. E, v ERA t~~ /~v E I.~uE
` - ~ea..e.saN~.r1
~R T~T. ~Uc t C- ~ , ST. LUG I E ~~~ ~,~
tc~s)
and this s4tement b to be taken as~~ deeLntion oi dtir.enship, act~d legal residenoe and domtc~e in tbe State d Florida.
" IP FOR THE PURPOSE~OP ENROLLING
CHILOREN IN SCHOOL~ PLEASE STATE
THEIR NAMES:
~
' ~r
I F fOR NOMESTEAO- PURPOSES~ --
PLEASE CHECKS ~
1981 fE~3 -2 P!~ 2~ 26
~ i1LfL• RhC ~~COFOf~C
S1.LUCIE CCUNTY.f:A
RORfR F~OITRAS
CLERit Cu~CUt' CCU~ ~ ~
kt r;.-rn ~•rn~: ~• - _
~~
515580
We. ~ue o~r .
~'FUftTAEA CE~tT'g'Y t6atx~vill register at ~ locat address when Lbe registration boo~s reopen. and o~mpb wk6 aD
other reqniremwts d a jegal resideat at this State.
i,Je wL o~r- we ~ i
~ FURT~R CERT'ff'Y tbat'!~ luve no int~e~ioo to r~etara to former domie~e. and 'i~ iat~nd to remais ia '
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_ F-orida. permane~,•. ;
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Sworn to aad snbsa~bed befa+e me tbb ~
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f~or~ ,st• .~c~~~e, FL ~3345 Z
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! R~R PQj'~RA~,, CLERK OF' CIRCUI T COC~2T •
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~ ST. l!G i E COUNTY, FL 1 OA • ..
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~ - BY: ~ , . ~ ~
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~ ~EPUTY I.LERK
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347
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