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Deciarat~on of Domicile and C~t~zens p c~
43'70'7
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TO THE CLERK OF THE CIRCUIT COURT. ~
ST . l UG I E COUNTY. FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Fbrida that I am filing this day is accordance, and is
conformity with Section 222.17. Florida Statutes.
I was formed a legal resident of f2. Al ~ U g L t~ ti£w U U_~_I~_ and I
ICit~l 1 1
resided at ?<< ~ ~ ~*~I" ~ ~ N ~ A ~ - . However. I have changed my domicile to
1 and Numbd ' ~
and am and have been a bona fide resident of the State of Florida mace day of
eiyv?_A Q.? _ 19~. and I reside at 1 O y ~ U ~ ~ ~ ~ Q t ~ O
(8te.at and Nvmbr) t
~;r"F ~ c ~ N Q ~'F}c .N ST . LUC 1 E County. Florida, 4
1~t71 i
and this statement is to be taken as my declaration of citizenship. actual legal r~aideace and domic~7e in the State of Florida. ~
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IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES, j~
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMES:
^ DED
,:.L? i.~iii r.~COR
43'702'7.`
'19 E L•_~ 13 PM 3 : 3 0
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain in
. T. U C I E _ County.
@ IC~ty) ~
Florida. permanenei; .
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Sworn to and subscn'bed before me this ~ day ~ S~ ~ ~
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_ A.D.19_ ~ / z
ROGER P01 TRAS, CLERK OF CIRCUIT COURT
ST. LUGIE COUNTY, FLORIDA ~
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BY: ~Z~
EPUTY LERK ~~Qp
3~Gr ~4 ~A~`28J0
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