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Declaration of Domicile and Ci$izen~hi
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~ 420329
TO THE CI,ERK OF TH~ CIRCUIT COURT~
ST. LUC I E COUNTY. FLORIDA:
This is my declaration ot Domicite and Citiacnship in tha State o/ Florida that 1 am Gling this day in aceocdance. nnd in
con[ormity with Section 222.1T, Florida Statnies.
I waa formcrl a legal resident of T ol e do , Oh i o and I ~
' ICilyl lState)
res;ded at T0~ B10~ s1n82'~ ,~O$.~ .~[oveever, I hAVe chan~ee! my domicile to
tStreet and NumDer)
~fla II[Il Arto i~az r isrr~~ "s arv:.o : :.~;a~^! ^i thc St~?lc of Fioride since S~1~* - ~ n dny Of
.19_3$__. and i mside at , 3200 SO • 7th StI`ee t( LOt L~ )
(Street and.Number)
ST , l. UG ( E County, Florida,
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and this statcment is to bc taken es my dezlaration ot citizcnship~ rctual lcgal residence and damicitc i;~ the St~.tr of f'torida.
I F f OR TfiE PURPOSE OF CIJRplL lt~G I F' FOR FIOl~iESTEAU PURPOSES~
CHtLDkEN IN SCNOOL~ PLE/+tiE STATE PLEASE CHECK: ~
TtfE tR t~AMES;
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I FL'lt1'Ii~:P. CE:ItTIt'Y that I will register ~t my locai address when tter registration Lw~ks reo~en, tcnd comply with all
other rrquircmcnts o[ a Icgal resident of thu State. ~
I F[IRTItF:~t CF,[iTIF'~` t}~~t 1 ha~•c no intc•ntion to rrturn to mv f~rmer domicilr, and I intend to rrmain in '
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lCit~l .
I~'lorida, pcrmanenti,~.
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S« orn to ~nd siih. cribcd bi•furc me this d:+y of ~
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- ,A.D.19_70
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ROGER POI 7RAS, CLEftK'. OF C{ RCU 1 T COtJRT ~ t~ ~
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ST . L tK I E COUNTY, F l0{t 1 A -
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BY:; ~
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