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!..~Vl.tC1li~:iL t. Ut u~.,.??EErtIC dtll.t _..;!?~ttiU
4~i62'70
>;O THE CLERK OF'lliE CIRCUIT COURT.
S~ . LUG 1 E COUNTY. FLORIDA: .
~ 4'his is m~ declaration of Domic~e and G~itiunsbip is the State of Florida that I am filing this daT in accordance. and in
conformity with Section 222.1?. Florida Statutes./~
' I was formed a legal resident of r ' ` ~ ~ C- C ~ N ~ • and I
~ IG1t~) . 15tata
resided at "1 ~ ~ NS ~ S~'~N~ ~ V~ fl~~ _ However. I have ehanged mT domicle to
(Stiset and Mamba) -
:nd am and have been a bona fide resident of the State of Florida since dal ~
F ~ ~ .19~ and I reside at ~ a- ~ E 2 ~ 0 f A ~ N t~ -
(3trest aadNombal
~'Q(~r S~ L U c ~ C _ ST. Luc I E Count,, Florida,
t(~tt71
and this statement is Lobe taken as m~ dec]aration of cotisenship, actual legal residenu and domiale 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
_ !919 NO't 16 Pk 2= 08
FILED pNt1 Fl CutuitU
ST.LUClE COUt~TY.FLA. ~
ROGER POtTRAS
CLERK CIr~:.Ut
462'70
I FURTHER CERTTF'Y that I will register at mT local address when the registration books reopen, and comply with all
~ other requirements os a legal resident of this State.
I FURTl~R CERTIFY that I have no IDtentlOn to return to m~ former domic~e, and I intend to remain in
~ T- U C I E , Count.
E _ lCit~) _
I
~ Florida. permaneati~_
r .r-
~f ~ It
- - (Name)
Srrgr~r ~ ore me this day of -
A_D.19~~/ .
ROGER POIIRAS. CLERK OF CIRCUIT COURT •
_ -
ST. LUGIE COUNTY, FLORIDA
BY:
' EPUTY LERK
. _ g~~3~0 15~!tr •
-