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Declaration of ~::::..~.r~t;,• Ci~izens~~~: _
468104 '
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG I E CpU~•y, FLORIDA:
Tbis is my declaration of Domip7e and Citizenship in the State of Florida that I am Sling this day in accordance. st?d in
conformity with Section 222,17. Florida Statutes.
I was fo,
rmerlr a legal resident of `I.'~ l1 ~ -~Ll ~
~ ~ . L ~ I
ICd71 1
resided at ~1 1----- o ~ ~ N fl ~ 1~~ However. I have ebanged my domiede to
(8trs~t and Numb~t) ~ f'~
and am and have been a bona Gde resident of the State of Fbrida since ~y ~
~ E ~ Yl~l l ~ / 19~ and I reside at ~ ~ ~ 5 ~ ~ / /,3 /1( 1~-
~ IStrMt and Nvmbr)
_ 1 ~ (I" ~ ~ ST. LUG I E qty, '
IClty) .
and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State of Fbrida.
IF FOR THE PURPOSE OF ENROI.LlNG IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOLr PLEASE STATE PLEASE CHECK:
THEIR NAMESS '
_
_ aor,~ : ~t I
- CtEf:~.. ~ cwn I
RECOF.~ , - , _
_ _ ~
" Otx ~ 12 of P!+ '1~
- 468104
I FURTHER CERTIFY that I w~71 register at my local address when the registration books reopen. and comply with aU
other requirements of a legal resident of this State.
I FURTHER CERTIFY tlut I have no intention b return tom former domicile. and I intend b remain in
C E County.
1(Sty) _
Fbrida. permanenu; .
,.,`_J::t. ,roc ? ~
•'dj.
~(i<V r ~ ~ - MOM) ~ ~ r'~ `'Z ~ .
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Swarm b ana'iw`d~efore me this day of •
- ROGER P01 TRASH CLERK OF C IRGUi T COURT 3/p aLNd~ ~NQ. C'? j
ST. LUGiE COUNTY, FLORtoA
BY:
r
EPUTY LERK
dU~ J~.L P~~~~
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