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aeciaratic~~ c. area Citiz~:.~>`~~° ~
468166
TO THE CLERK OF THE CIItCUIT COURT.
ST. LUG I E (~pUNTy, FLORIDA:
This is my declaration of Domicile and Citizenship in the Stale of Florida that I am 51ing this day in aoeordanos, and in
conformity with Section 222.17, Florida Statutes. ?
I was formerly a legal naident of ^ ~ ~ / jDn~;_ i?%1 /I 1 f
~ 1 n>> (Statel ~
resided at ~~n o~ . However. I have changed my domicile to
(St~wl end NumEer)
and am and have been a bona 5de resident of the State of Fbrida since 2 Y day of
~/'A,t,~? ~ 19~ and I aside at : ~ ~ l~l~ ~ f f ~P~'!S ~R' i•~'~
lStrwt sad Nnmbe)
_ ~ ~ 7' ~
,1' ~ C 1 C! ~ ~ ~ ST . LUG I E County. Florida,
Icy) i
a~ *_?+is 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 ENROLLING IF FOR HOMESTEAD PURPOSES,
CNIIOREN IN SCHOOL, Pt.EASE STATE PEASE CNECK:
THEIR NAMES:
FiE'~oK~t 1~~ ~P.h~ ~r~ ~~~~'t~ lE0 ANC N~ ..~n0E0
_ - - RECOar ~t=~
II~C ~ Z 27 PM l
I
468166
I FURTHER CERTIFY that I wi71 register at my local address when the registration books reopen, and comply with all •
other reQuinments of a 1ega1 resident of this S4te.
I FURTHER CERTIFY that I have no intention to return to my former domicile_ . and I intend to amain in
, 3~ . L l/ C 1 E ~ County,
ICsy)
i
Florida, permanents; .
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w~ r „ _'1 1 ~
Sworn W and snbscn'bed before me this dsy of ~'l ~ ~ _ ~ f C~) ~ ~,i
- ROGER P0ITRAS. CLERK OF CIRCUIT COURT
ST. LUGIE COUNTY, FLORIDA
EPUTY JERK •
8C 7K 321 PAGE ~3~