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Declaration of Dornici~e a~~d Li<<zenshi~ ~
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45748
lop THE CLERK OF THE CIRCUIT COURT.
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S~~. LUG 1 E COUNTY, FLORIDA: ,
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;This is my decLration of Domia7e and Citizenship is the State at Fkrida that I am flias this day in aooordanee, and is
ooafonaity with section 2?Z.17. Fbrida statute:. ~ c .
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I was iorn?erl a kgai resident o[ ~ ~
1 IStaW
~U~ However, I have changed my domie~7e to
resided at
IStisat ombarl
and am and have been a bona Sde resident of the S4te of F]orida since ~1 P~ ~7 °i
19!
/ - and I reside at ~~U" ~ Ur ~
^ _ 13c*+~t and Nmbirl
jy.~. ~ ~ ~ p ~ ST . l UG 1 E Count, Florida.
IIxt71
and this statement is to be taken as my declaration of citizenship. actual legal residence and domicRe in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES~t
GHIIDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMESS
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R~CaRO VERtf1ED
- 45'7418
j I FURTHER CEBTI>:'Y that I w~ register at my lord address when the registration books reopen. and comply with aD
r other requirements of a kgal resident of this State.
I FURTHER t~ItTIFY tb:t I have no intention to return to my iorme~
r domie~e. and I intend to i''nmain in
J T. ~ v~ ~ c County.
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Florida. permanend;.
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l~~E %01l~ ~ IAddt~al
Sworn to and ore me this ~ day Oi
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A.D.19;~/ - - - t
R A C ERK OF CIRCUIT COURT ,
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ST. LUGIE COUNTY, FLOR OA - -
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BY• _ _ ~ -
C
• EPUTY t.ERK F
- • g~}x315 P~21~9 - ~
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