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Declaration of Domicile and Citiienship
4634'71
TO THE CLERK OF THE CIRCUIT COURT.
ST . L UC I E COUNTY. l~-I,ORIDA;
This is my declaration of Domicile and Citizenship in the State of Fbrida that I am Ring this day in accordance. and is
conforupt~+ with Section 222.17. Florida Statutes. ~ /
I was formerly a legal resident of - ~ ~ I
ICtt~l l8tata)
resided at / s A ~j' /~~D'7 ~I /V ` C . However. I have changed my domicile to
(8tnd ~sd Number) ~
and am and have been a bona fide resident of the State of Florida since j` a day of
q ~
.19~. and beside at -~S ~ s ~ ~l'~~ 1 C L G
~ (8trMt sad Number
~ f 1 _ ~ t, _ S T . L UC I E County. Florida.
IOityl
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE Of ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES2
7 ~ ~9i9 OAT 23 3: 02
F!tEQ AhC rELL!._E;1
ST:LUCIE CGJYTY.FL:,.
ROGER Ps11TRAS
CLERK C!.'.:t,T CGt;•";~
4634'71
I FURTHER CERTIFY that I wi11 register at my local address when the registration books reopen. and comply with aD
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return tom former domicile. and I intend to remain in
U C 1 E County. '
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~ Florida. permanents; .
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~ ~ Sworn to Illnd snb~sen'bed before me this ~ day of ~~L~Y1 ~ 3 ~f
A ROGER P01 TRAS. CLERK OF C 1RGU1 T COURT
~ ST. LUGIE COUNTY, FLORIDA
_ '
1 BY: -
i
EPUTY LERK
r 318 p~2!~ ~ ~
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