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TO Tllt~: CI.N:IiK UH' TIiE: CII~Cl11T COUItT. .
ST,~l.l1C 1 E (jpUNTY. F'IARIDA:
Thi~ is my c!eclaration ot I)umirile And Gitizons}~ip in tho State ot Florida thnt 1 am Cling thie day ln accordanco. and in.
c~ontorautr with Scction 222.17, Fiorida Statules.
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l was ~orm~~r~ a l~gal re~idrM oi -vE'~R ~~L ,.L~L~~ ' ~?nd I ~
' (Cityi tstate) 4
resided at `~7 ~ j,~L!_. PdC /~IV~1~/~ . liowavor. I have ebangcd my domicile to ~
. (Street and NumDe~r) • ~
And sm dnd have becn a bona Cdc+ re~ident o[ ti~e State o! Florids si..ce ~7f day of 1-
_ -19__~ And 1 reside at ,~6Q0 S. Fe~~. 4/,~
. lStreat sad Numberl
e c.Q ST. LUC 1 E ~ Countr, Florida. `
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and this stt~tement i.s to be taken as my declsration o[ cit'v.enship. ettual legal rosidence end domicite in tha Stalo of Florida. ~
If FOR 7HE PURPOSE OF ~NROILING If POR HOMESTEAD PURPOSES~
CHILDREI~ IN SCHOOL~ PLEASE STATE PIEASE GHECK2 ~ :
THEIR NANES: . '
Da rr~n~ 3 rt•~,s !-~r ~
ANER~ a. ~ r Ct,~l~ ~t,^.
~ - '.•d'.. R~~ORU~O
. ' . -.1,~•TY `
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4~251
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I FURTIfEIi CERTIFY that I witl register at my loca) address when the registration books reopen, aad comply with all
other requirements oi a legul resident of this State.
I FURTHE~ CF•RTTFY that I havc no intenlion to rnturn to mv tormer domicile. and I intend to rnmain in
~ . U C t E . County.
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Florida, permanenti;. .
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Sw~orn to and subscribed be(are me this clay oi
n-.r~. 7 g
ROGCR F'01 TRAS, CLE'F2K OF C IF~CUI T CO(x21~
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ST. LUGIE GOUNTY, F~(~R~1UA ~ `
BY: ~
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PurY ccHr -
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