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Ueciara~on or ~orniciie and Ci cizenshi
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454952.
1~O THE CLERK OF Tl~ CIItCU1T COURT.
Shy LUC 1 E F-
COUNTY. FLORIDA: `
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° ~ Thb b mT detlaratioa o! Doovie3le and Citireaship in the Stag a< Florida that I am bins thb dq is soootdanoe. and is -
_ ooniormjts with Section 222.17. Florida Statutes. -
I was lorme a resident o! BUFFALO NEW YORK and I
- 6 8 TAYLOR DRIVE 18tat~i
at However. I have changed mT domids to s
t8tnat aaa r1o®Dwl -
aad smand have been a bona Ede resident o! tbs State olFlorida since dal of }
APRI•t 76 1117 $W IRVING STREET i
- 19 - and I reside at
PORT S T. L U C~ I E 18tr.~t ~d N~t+~
ST. lUG I E Count.
cctcrl
sad this statement is to be taken as m~ declaration o! atizenship. actual legal residence and domieDe ia.the State at Florida.
IF iOR THE PURPOSE OF ENROtLiNG ~ IF FOR HOMESTEAD PURPOSES,
CHIt.OREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THsIR NAMESS ~ F
S Kh! O R A F R O N .454952
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~U6 ~~1 PN G• 2
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5~~~~"~OI RASA S
d~+~C1AT COURT
RECORD VFfIIFIED
THIS fS TO CERTIFY THAT ~ HAVE TEMPORARY CUSTODY OF SANDRA FRON
AttO SHE ! S A RES 1 OE~:T OF ST. LUC I E COUNTY FLA. OUE TO SA 1 D
CUSTODY.
~ I FURTHER CER1'I>:'Y that I wtU register at m~ Iocal addrsas when the registration hooks reopen, and eompl~ with all
{ other requti:ements d a legal resident ai this State.
1 FvA1'l~R CERTIFY that I have ao intention to return to mF iora~er domicile, and I intend to remain in
U C E Couat~.
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Florida. pesmanead;.
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Sworn to and sobsrn'bed before me this / daT ~
~
A.D.19~~/
R ER A CLERK OF CIRCUIT COURT
ST. lUG1E COUNTY, FLORIDA -
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BY S -
EPUTY t.ERK -
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