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Declaration of Domicile and Citizenshi
P
4~~92~
TO THE CLERK OF THE CIRCUIT COURT.
ST . LUG 1 E COUNTY, FIARIDA:
This is my declaration of Domia7e and Citizenship in the State of Fbrida that I am filing this day in aeoordanoe. and in
oontormit~ with Section ?12.17. Florida Statutes.
I was low a legal resKleni: obi Z ~'1'
IL~t71 IState)
resided at 7 3 1~~~Ct~L~ ~~1'Lo'YS- ~ . However. I have changed mlr domit~7e to !
l8trMt asd Numer) ~ ~ 1
and am and have been a bona fide resident of the State of Florida since r? ~ ~ ~7 d
• ,19_.~., and I aside at ~ $ ~ ~l~lt.•L V VLa- ~?/}-~.Yri
(StrNC and Nambr)
~ ST . LUG 1 E County. Florida.
(C~ql
and this statement is to be taken as my decoration of eitisenship, actual legal residence and domia7e in the State oI Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHitDREH iN SCHOt3t, Pi_EASE STA3E Pi.EASE CHECK:
THEIR NAMES:
~'9 Get 26 Q7 i
aT LlICtE t'OUVTY.it A.
ROGER t'OITRAS
CLERK CtR,,L•!T CCG"2Qf
46928
I FURTHER CERTIFY that I wdl register at my local address when the registration hooka reopen, and comply with all
other requirements of a legal resident of this State.
F
~ I FURTHER CERTII''Y thst I have no intention to return tom former domicile, and I intend to remain in
_ U C t E _ County,
ICat~l o v-L~.u-
j Florida. permanenci;. - #
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Sworn to and ~tor`+e me this day of
i
J - 9 .
ROGER P01 TRAS, CLERK OF-CIRCUIT COURT aS'I /LIftR~~Nf! .Dr'.
ST. LUGIE COUNTY, FtOR1OA ,
BY: _ -
EPUTY LERK -
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n~ 3~.9 P~~E 627 . , ,
fin. K . . s ~
ICA r_~ e..r.