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Declar4~~w,:. ~ ~ornici~e ana Citizenship ~
4~79~~
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E COUNTY. FLORIDA:
This is mp declaration of Domic7e and Citiasmhip in the State at Fbrida that I am filing this daT in aooordanoe, and in
conformitT with Section 222.17 Florida^Statutes. `
I was former a legal resident of 1~ ~ and I
_ r, tpt~) (State)
resided:t ~ y ~ ~ ~ ~ ` S ~ c~' > ti~ ~ • . However. I love changed mU' domits7e to
IStre~t and Nnmbr)
and am and have been a bona tide resident of the State oaf Florida since 2 ~ daT of
i-
~ 7 ~ .19~... and I reside at ~ ~ ~ ~
ft ~ ~V C~ ~ ~ d
~ (8treet aed Numbs)
_ ~ j,~ p_ t ~ t c ~ ~ ST. LUC i E Count. Florida,
ta4?
and this statement is to be taken as m declaration ~ citisens ' .actual
7 htp legal residence and domicile in the State opt Florida.
IF POR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOO~r PLEASE STATE PLEASE CHECK2
THEIR NAMESL 1
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Ft~EO AM;~ r :..::UEO
aa~~ : .,s
CIEF.~ ~ ~ ~~J
Q~ 3 2 is PM '?9
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46797
I FiJRTI~R CERTIFY that I w01 register at my local address when the registration boob reopen. and oomplT with all
other requirements of a legal resident of this State.
i
I FURTHER CERTII~'Y that I have no intention to return tom former domicile. and I intend to remain in
~4C~ ~ ~ T . U C I E ~ Cou~y.
ICaj)
Florida. permaaeati, . ~ ~
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Swore to and subcn'bed before me this ~ daT of 2 G ~ ~ fi ~n ~ d 1~- ~ R. ~ U , ~ 1 ~ ~ ~ ~ '
9 r
ROGER PO I TRAS. CLERK OF CIRCUIT COURT
ST. LUGIE COUNTY, I:LORIOA
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9Yt `
EPUTY RK
a~~x 321 P~~E 1~7 ~ .
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