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Declaration of Domicile and citizenship
462536
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E COUNTY, FLORIDA;
This is my declaration of Domicile and Citizenship In the State of Fbrida that I am filing this day in accordance. and in
conformity with Section 222.17. Florida Statutes.
I ryas formerly a kgsl resident of ~'iJ _ and I
. (CYt~I (Stag
resided at _ 7~~ - However. I bave ebanged m, domicDe to
~s><,..c.aa N~~
and am and have been a bona 5de resident of the State of Florida since ~ day of
~
1J~~~' 19~. and I reside at f ~ip.c7/9~it/
(8tteat and Noabt)
~~-~f ST. LUG 1 E Co~nh. Florida.
u~tl
sad this statement is to be taken as my declaration of citizenship. actual legal residence and domict'k in the State of Fbrida.
f
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NANES2
. L7Dl.~ ~.Q~-, .
~1/GEi2 /l7. ~,~`r, ~ ;979 QCT i S k~l ~ I ~ 25
FILEO I~N£ ~:CO~c%f U
ST.LUCIE CCUNTY.FLA. s
ROGER POITRAS ~
CLERK CIRC~JIT COIjFT ,
REC~~'; ~'FIf1•~• ~ /i'
-
462536
I FURTHER CERTIFY that I rvdl register at my local address when the registration boob reopen. and comply .vith all
other requirements of a legal resident of this State.
I FURTHER CER1'i>:'Y that I have no intention to return tom former domicile. and I intend to remain in
- - _ t. ~ U c i~ ,County.
(t~crl .
Florida. permsneau; .
g, COUiyl ~
J~ '~~~3:
/ tAdder~
Sworn to and subscribed before me this day of / r/ ~ -~7,f ~-4 f ~l
_i9 .
_ _ _
.79
ROGER
POI~AS,
CLERK OF GIRGUIT GOURT
ST. LUGIE COUNTY, FLORtOA ,
Yw i~ i ~~r~s~ ,f.