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Dectaru~a~~ of Domicile and Citizenship
46442'7
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUC 1 E COUIyTY. FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am Sling this day in aceordanoe. and in
conformity with Section 722.17. Florida Statutes.
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I was formerlg a legal resident of "t~~~-.~~+ and I
ICity) IStatel
resided at ~J C S ~~-~-~~2T~ > ~ ~ -cam. However. I have changed my domicile to
(S NumAw1
and am and have been a bona fide resident of the State of Florida since C~ day of
~6' ~ ~ ,19~. and I reside at ~ s S
~ IStreet and Number)
. S T . LUG 1 E County. Florida,
1(~ty)
and this statement is to be taken as my declaration of eitiuaship. actual legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES
CHILDREN IN SCHOOLr PLEASE STATE PLEASE CHECK:
THEIR NAMES: ,
~ ~
S ROGER~~~IZRA~A
. ctc1;K c~r.;~u~T Court
441442'7
I'I. I FURTHER CERTIFY that I wi71 register at my local address when the registration books reopen. and comply with aU
otber requirements of a legal resident of this State.
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i I FURTHER CERTIFY that I ve ao intention to return tom former domicile, and I intend to remain in
T. U C I E County.
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Florida. permanents; .
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f _ _ )
..,S' ~'to ~sdbcen'bed before met ~ ~ day of
- - - i
,L a h
~ ~ -A.D.19i C t~q
P01~ A C ERK OF C1~ GUIT COURT
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ST. LUGIE COUNTY, FtOR10 -
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BY: - 1 ~
~ EPUTY LERK ; 'S ; ~
8319 ~ ' ,