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Declaration of Dom~c~le and C~tizenshrp
435344
TO THE CLEAK OR THE CIRCUIT COURT.
ST. LUG 1 E COUNTY. FIARIDA:
This b my declaration d DQiaicile ind Citisnship In the State d Florida that I am filing this day is scoordanoe. and in
conformity with Seetioo 222.17. Florida Stagtea.
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1 was former a legal resident d Cs^^ rC r b ~ r.r ~ ~ - C O and I 1
' ICk~I l8t't~1 ' f
resided at C Q rti.eT~ r• v ~ N 8 "1 - However. I have changed m~ domicde to
lStre~t NnsbK) ~ -
and sm and have been a bona fide resident d the State d Florids since ~ +s, f
s T day d i
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19~~.. and I reside at b.
t 73 ~ ` • • °
(St»st.adNnmbe) ~ s
- ST. ~ lUG I E County. Florida.
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and this statement is to be taken as my decLration of citizenship. actual legal residence and domic~7e in the State d Florida. ~
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IF FOR THE PURPOSE OF ENROLLING IF FOR HONESTEAO PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THE 1 R NAMESS - ~
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KQbinSOh/ t7,F~_~
FIt_EO-AND RECORD~[)~,_
J~`y~LT~n ~ - ~ ~~Q_ytJ ~T. LUCiIn COUNTY. FLA.
- 434
'79 FEB 26 PN 3 ~ 52
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I'i I FURTHER CERTIFY that I wRl register at my local address when the registration books reopen. and comply with all
other requirements of a legal resident of this State: g
~ I FURTHER CERTIFY that I have ao intention to_return to my .former domicde. and I intend to remain in
- J 7. ~ u a ,County, ~
Florida. permanend;. .
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(Name)
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Sworn to and subsen'bed before me this ~ ~ day of
r --7T - t
. A.D.19_ ~ / 1
ROGER P01 TRASH CLERK OF G IRGUi T COURT
ST. LUGIE COUNTY, FLORtUA - ;
BY:
EPUTY LERK ~
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