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Deciaration of Domicile and Citizenship
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TO THE CLERK OF THE CIRCUIT COURT. 31843~
ST. LUC i E (~pUNTy, FI,pRIDA:
This b apr declaration ot Domjcik and Citlzeaship ia tbe 5tate ot Florida that I am tiltng this da~r ia ~ecoedaace. and in
~oatormity ~rith Seetion 222.17. Fbrida Statutes.
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I wu toemerl a kgal reaideat ot °~r 0.~ S Q .a~• a..•c~a ~ I
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resided at O~ 3 - Nowever. I have ehanged a4Y domicile to
(BtrMt ~d Nasbw) `
aad un aad have beea a bons Gde resident ot the State ot Fbrida siaoe ~~`n dsr ot ~
C'~ _ a `
S~ 19^75 and I reside at S'~ v C~C. ~ r f
~ ~ . \ lStewt and Nombtl -
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aAd this statement is to be lakea aa my deelaration of eitiunship, aetud kga! residence and domic~e ia the State oi Flo*ida.
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ir ic~f~ i~E PtiitFCiS~ C~~ ~netul~inv ii ivn iiiii~~ai~inv i-'vR~v~~~~ -
CHIL~REN IN SCHOO~~ PIEASE STATE PLEASE CHECKS ~
THEIR NAMESS
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ST_ LUC+~ C:; :'NTY F~A.
ROG= .,;"RAS 1
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OCT 1 10 ~'~~J
31.843~3
I FURTHER CERTIFY that I will register at my loeal address when the registntion books reopen. and eomply with all
other requirements ot a legal resident of this State.
I FURTHF~ CEftTIFY that I have no intention to return to my tormer domicile. and I intend to remain ia
• ~ ~ - { ~ ~ , ST . L u c ~ e . County, F
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~ Florida. permanenti; .
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R Sworn to snd subscribrd betore me this ~ day oE _ `~D- J~ :
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- ROGER PO I TRAS CL~RK OF C I RCU I T• v~~ ~
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; ST. Ll1G1E COUNTY, FLORIUA '.c°.~' ~ .
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t . ~ soox 244 ~ 1516
t - AGO Form T1 ~22 ~
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