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Declaration of Domicile and Citizenship
464213
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUC 1 E COUNTY. FLORIDA:
This is my declaration of Domic~7e and Cttisenship in the State of Florida that I am tiling this day in aecordanoe. and in
eontortnit; with Section 222.17. Florida Statutes. /
_ _I was formerly a legal resident of - ~ /T TQ ~ _ ~-%~i ~ O . I ~
lQ / , ~ p
resided at 1~ ~ ~ ~I~L.T~~-/~i'~-~~ ~l
~ . However. I have changed m_
y domicile to
(Strea/ and Nnmba'1
i~E~ .
and am and have been a bona fide resident of the State of Florida since - day ~ i
~~G~~
' T X ~c~?~/ O.~ f~c~lrp~v5 ~v~
,19 /
U
- aad I reside at
lswd.ad N
~T ST . L UC I E County. Florida.
caul
and this statement is to be taken as my declaration of citizenship. actual legal residence and domiale in the State of Florida.
IF fOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES, ~
CHILDREN IN SCHOOL, PEEASE STATE PLEASE CHECKS ~ '
THEIR NAMES: ~
s
i
:3?~ ~^T 29 Phi 2- Q4
~:~_o sae 'r~ cuK::~a ~
S ROG
R PGITR~ SA '
C;.ERK CtRCilIT COJJR[~'
464213
I FURTHER CERTIFY that I will register at my local address when the registration books reopen. and comply with all
other requirements of a legal resident of this State.
I FURTHER CE that I .have no inttntion to return tom former domicile. and I intend to remain in
U C 1 E ~ County.
Florida. permanenti; .
- -
(Hama) /
IAddraaa)
Sworn to and subsrn'bed before me this ~ ~ day of i1~-e.~ ~L~(-/.
A.D.19, 7/
i
ROGER P01 TRASa CLERK OF CIRCUIT COURT
ST. LUGIE COUNTY, FLORIDA
EPUTY LERK 3
30~K319 PA6E~~~ y --•"i
AG(1 Form 11.22