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Dectaration of Domicife and Citiz~nship
~1~3488
TO TEIE CGERK OF TI~E CIRCUIT COURT.
ST. LUG 1 E CpUNTY~ f'I,ORIDA: •
Thu is my declaration ot Domicila ~nd Citizenahip in the State of Florida that I am GGng this day ia aceordance. and in
ton[ormity with Section 222.17. Florida 5tatutcs.
I wu torm~rl s legal resident o[ V~/ l 1 f"' = l~` ' and I
ICit71 1~e1
resided at ~~~~2_~~ ~c~ ~s/ CJ"~ . Nowever, I hsve ehanged my domicile to
(Stnet aed Numbst)
y T~i
and am and havP bcen a bon~ Gdc re~idcnt ot the Stete ot FMrida since ~ ~ - day ot
.19t
6 end I reside at ~ ~ ~ ~~'S~
~ (Streec and IZumber)
~~2/ ~_11. _ L. r1c e l~~. ~ ST . L UG I E Councy. Florid..
lCit~l
and this statcme~t is to bc taken as my declsration ot citizenship, actual Icgal m.ridence and domicilc in the State ot Florids.
I F F012 T{iE PUP.POSE OF ENROLI ING i F FOR HOHES7EA0 PURPOSES~
CHIIDREN IH SCHOOL~ PLEASE SYATE P~EASE CHECK: ~
THE IR ~IAMES:
~ L~ 3, ~~ti L~ 1
/f/~ ~y ~ FIIED AND ftEC0~UE0
1"~ ~ L~G.L! ~ St. RGGIE.CO~UN~~g ~A.
L31~ ~f~ ~ i / 1 /~,L,~f~ ~~ca. -•~~~?G~`a
..L
- S~P 28 l! 3~ AN~'T8
418488
i I FUR1't1E:R CERTTFY that I will regist~rr at my local address a hen the registration books reopen, and conply wit4~ sU
' othcr rcquircmc~nts oi a teKal reside~t of th~s Slate.
I FUItTIII~::3 Cf:RTIFY that 1 hav~ no intrntion to mturn to my [~~rmer domicile, ~nd I'intend to rcmain in
T_ _ U C 1 E County.
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.lCit~) • ' U ~ , ~
~ Florida, pcrmancnti;.
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" Sw•orn to and sutrscrilx~d before me this day of /QT v~ !
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~ ROGER P01 AS. CI.ERK OF CIRCUI T COU2T -
~ ST. LUGIE GOUNTY, F~ORIUA ~ ~ ~
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~ BY. ;~K295 85
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