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Declaration of Dor~icite anc~ CiY~zens~i~~ ~
. 48~6?424
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1~0 THE I~.ERR OF THE CDtCtIIT OOURT.
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S'~. lUG 1 E WUN'1'Y. FLORIDA: .
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~ `'This is ~ declaration d Domid7e and Qit;sensbip is the State et Florida that I am Ain this dp is aooo~daooe. and is
- _ aonlermit,~ with Seetian 13.17. Floeida Statutes. ~ - .
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I was ~ a kEal resided ai C~ ~ ~ ,
1 IstaW
resided a ~ ~ ~ ~ O ~ ~ - Aowever. I have cbaased mT domiea'1e fA
18tr.d.ad Tlmat~ .
_ and am and have been a boas 5de resident o[ the State d Florida since ~ ~1 d
• • ~ G-_ . I!~ and I reside a o w d O L t -
~D • ~ ~ S _ V 1"j ~ ~ ST. LUG 1 E Connq. Florida, .
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and this statement is to be taken as nn declaration d dtiunsbip. actual kgal resideaoe and domicie is the State d Florida.
IF FOR THE PURPOSE Oi ENROLLING IF FOR HOMESTEAp PURPOSES,
CH-tLQREN- iN SCHOOLS PLEASE STATE :-::PI#~EASE --CHECK:
THEIR .NAMES: ~
I~T~ AUG 2B AK a 53
o ANO~R~cJ~~x~b
- POITRA~A.
CIRI~AT
REC0110 VERIFIED
456424
I FUR1~ft CERTII~'Y that I w~ register at mT local address when the registratmn boob reopen, and aoniplF with aD
other regmrements d a kgal reside. of this State.
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I F'tJATi~R (~Ei1'ff'Y that I have ao intentiaa to return to m7 former domicile. and I intend to remain is
. T~ U G 1 E Conatj,
I _ ~ I~il -
~ F7osda. Permanensli
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. _ c h COUNT
Vi .y - - .
s ~ ~~tiFCO "~t~°v
Sworn so and sobeasbed before me this ~ daT of
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E A.D.19
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~ R A CLERK OF CIRCUIT COtitT
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ST. LUGIE COUNTY, FLOR1 _ .
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' EPUTY LERK '
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