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Declaration of Dom~c~le and Cit~zensh~p i
4~i3326
TO THE CLERK OF THE CIRCUITCOURT. -
ST. LUG ! E f;OU~•y~ ~,p~A; _
This is uU? declaration of Domicde and Citisensbip in the State of Florida that I am filing this day in aceordaace, and in
coaformit~? with Section 222.17, Florida Statutes.
~ ;
I was formerly a legal resident of ' `C> C F AG1/l~r~ -F'CiptNS~_ / ~ I f
resides:t [ ~ 3 ~'l[ C ~ ~ S~7L ~-Pf'-' lst.a)
18~ aed ivomb.r) However. I have changed my domica7e to ~
and am and have been a bona tide resident of the State at Fbrida since ~ c~ ~ O day of
~ -P ,19 sad I reside at c~ S- ~ • C } ' ~ y 1 ~ r ~ UC ~
9' ~ i-- ST. LUG 1 E~~x~)
(City) County. Florida.
and this statement is to be taken as my declaration of eitizeaship. actual legal residence and domicile in the State ~ Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMES:
~9~9 CST 22 ~ I~ G3
FilEt) ANC *tLUr'.Ut!~
SL LUCIE CL~JY t Y. F!
ROGER PO{TR4S
CLEP.KC{RCL'1T CCU.~T
REC.^.'r:' C[ ~ i ~ _ . _
4~332b
I FURTHER CERTIFY that I w~l register at my ktcal address when the registration books reopen, and comply with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no saltation to return to' my former domicile. and I intend to amain in
_ U C I E ,county,
ICtt~)
Florida, permanents; .
c ~ ~ - .~~-Q-
ra =
' ,C~
'~5
3wo~ra for and subserlbed Lfore me ibis ~ day of
r _ Y)~t-1 ~ - G Div n ,q A 8r2A ~,S
i~ . A.D.19i
_
ROGER POI 7RAS. CLERK OF G tRGUf T COURT
ST. LUCIE COUNTY, i:~OR A
. i
- -
BY: S, _ .a
_ EPUTY LERK
eu~~3i8 P~~E274~ ~ -
Af.O Form 71