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467836
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG i
E _ CpUIVTy~ F•I,pRIDA,
This is my declaration of Domitik and Citisenship in the State of Fbrida that I am Sting this day in aooordanoe. acrd in
conformity with Section 222.17. Fbrida Statutes. -
I was formerly a legal resident of SCE t ~z ~.e tJ~ I /r _ ~ Nn !A tia a~ I
i(~t~l tStatal
resided at 30~'] ~v _Fi? Eft.4.?o,p D . However. I have changed my domic~7e to
t, ltttraat and Nambd
aDa am area uaV ~k:vu ~ i,i.a'i~ ~8 r$3~gf$: w w~, vQ:,.* rlr.;
~si4 /S/~ 1/ rs? f~ , ? _ dal of
19~~ and I reside at S ~ ~ ~ ~4 ~C _
[~oQ7• S~ f` J C i G ST. LUG I Et~..ca.aHame.rl
cahl County. k`lorida.
and this statement is to be taken ss my declaration o[ citizenship. actual legal r+saidenee and domia7e in the SLte of Florida.
IF FOR THE PURPOSE Of ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS ~
THEIR NAMESS
~2iGF~~ D/so.`1 '
FI!LED iNL• rt . _ htlEO
>1T. ROME C FLA.
S
- CLERK ~ i CwUn
• RECOe^
-
~ 3 9 Ze AM '~9
4b'~836
1
I FURTHER CERTIFY that I will ~^egister at my local address when the registration hooka r+eopea. and comply with all .
other ngnisements 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 G 1 E County.
1(~ty1 _
Florida. permanenci; .
r t
~ ~OUhT
Cif CCU`it`~ •E~ I
Sworn to a l fore me this 3 ~ day of X~` .
y
- ROGER POI TRAS. CLERK OF C IRGUI T GOl~2T
ST. LUGIE COUNTY, FLORtOA
,
gY:
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EPUTY LERK '
gfl~K321 PacE ~2
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