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462518
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG I E COUNTY. FLORIDA:
This is'>ogy decLratioa of Domicile and Citizenship in the State of Florida that I am filing this day in aecordanoe. and in
conformity with Section 222.17. Florida Statutes.
_
I was former a kgal nsideat of ~ ~ _ ~ and I ~ ~
IC[hl (&atd
resided at ~ f ~ However. I have changed my domicile to
(Street and Numbarl
aad am and have been a bona fide resident of the State of Florida since day ad !
1
19~. and I reside at n Cr~ R u n lA 1 c T ~ ~
18t~+et,oa ,~e•rl ~ ~
Plan P ST. LUG I E
«sc~l
and this statement is b be taken as my declaration of citizenship, actual legal residence and domicile in the State a[ Florida.
I i' FOR THE PtlRP05E ot: i:Nitfiti i NG I is l= uR HO#EST€AO ~-v:<Pt~SESs
CHILDREN IN SCNOOt.s PLEASE STATE PLEASE CHECK: ~ _3
THEIR NAMESt
s
si9 OCR I S Ali ~3
i
ST.iU (E GO'.i*iSY.F V
RpG~R pGiTRAS '
~,EAK CiRCl1tT COURT : #
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462518
3
I FURTHER CERTIFY that I w$1 register at my local address when the registration books reopen, and comply with all
other requirements o! a legal resident of this State.
I FURTHER CER that I have no intcntioa b return b my former domia7e. and I intend b remain in
T. U C I E , qty,
1(St~) _ i
Florida. permanentj, : !
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f`~counrlyc ? ~ ~ L~.e ~
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o T~. :G a03 ~Q.^ a~"e~ l7nrN ~o+/U e s
•L~~-~ tq~S: •Q\~ fir- p~ e rc e, 7~La
Gc~F COUi1S`I ,E~•O (Addrw)
sworn to and an me this I S day of t Q ~
~t~~.c,C.(- . A.D.19
; ~1 - - v ~ c K i -e C : -
ROGER P01 TRAS. CLERK OF CIRCUIT COURT S~-ePP
ST. LUGIE COUNTY, ftORtDA -
BY:
- EPUTY LERK ~ ~