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TO THE CLERK OF TH>r CIItCt7IT OOURT. _ ,
ST. lUG I E ~OVrI'rY. FLORIDA:
This b'1gT fieeLration d Do®ie~e and C~iti:enship in the State d Florida that I am Sling this dq is aooordaaes. and k
eoniormitj wHh Section 222.17. Florida S//fatales. - i
I was formerh a legal resident d 4~~f,~ C ~ ~ cS0 uT1 f/ _ /1~~ ~O~K ~ and I _
(~7) 18tats)-
resided at / 7? GI~~rvF /fir E However. I have changed aq domiea7e to
(sn..t sod N~m1~d -
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and am and have been a bona Sde resident of the state of Florida since l ~ daF d
~f~T'E/~ 3E ~ 19~_. and I reside at 7l 9 ~/V~ L Od PE l~ E ;
ISb+~tasdllnmbr) -
~o~l' S 1. ~ ve ~ E ST. LUG I E ~ti.
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andthis statement is to be taken as m7 declaration of citisenahip. adusl legal residence and domic9e in the State ei Florida.
IF iOR THE PURPOSE OP EMROll.1NG IF POR HONEST.EAD PURPOSES,
CH I IOREN I N SCHOOL, P~ EASE STATE - PLEASE CHECKS j-----a
THEIR NAMES:
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1919 SFP 27 A!~ ~ _4p ` i
FI~EO aI~? PECOkoEO
sr.iuclECOUr, r.FiA.
- _ RosEA Pa~Ras
CLERK CIRCUIT ~ -
RECORD VEltIFIEp_~ ~
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I FURTHER CERTTF'Y that I svID register at my local address when the registntkn books reopen. and eompl~ witb all
other regniremeats d a legal resident ad this State. ~ -
I FURTHER CERTII•'Y tbst I have ao intention to return to m~ former domies7e. and I intend to reauin in
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Florida. petmsnentl,:
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sworn to ~
sued before me this ~ dad d S~. ~ ~,Q~
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ROGER POI TRAS, CLERK OF CIRCUIT COURT
ST. IUGiE COUNTY, FLORtOA - _
BY:
EPUTY L.ERK - k
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