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~:~~caration a~ : ~i~i~e and Cif~~enshi ~
~ ~
~~ss~s
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUC 1 E COUNTY. FLORIDA:
This is my declaration at Domiede and Citizenship is the State of Florida tb,:t I am Sling this day in aowrdaace. and In
conformity with Section ?22.17. Florida Statutes.
r
I was formerly a bgal resident of ~ ~ sad I
~a l(aity) 18tab1 1
resided at ~ ~ ~ ~ ~ ~ . However. I Nava changed my domidle to t
18trwt sad Nsmbr) j'
and am sad have been a bona fide resident of the State of Florida since ~ ~ day of 1
,19 and I reside i
(BtrNt sad Nomba) ~ .
_ l.(1~j / f
-ems ~ L ~ ~ S T . L UG I E County. Florida.
(City) t
and this statement is to be taken as my declaration of citizenship. actual legal residence sad domicile in the State a[ Florida. !
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,
If POR THE PURPOSE OF ENROLLING IP FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
TH 1 R NAMES:
- - S e 1.~- ~ ~ f ~io r~
/ / i
CLERK. ~ _ - ~ BUR
RECOa'~ ' ~ ~
- _ ~c 1 9 ~9 I~'79
I~
4~i8658 1
I FURTHER CERTIFY that I wt71 register at my local address when the registration books reopen. sad comply with aU
other requirements of a legal resident of this S4te.
I FURTHER CERTIFY that I have no intention to return tom former domic~7e. and I intend to remain in
~ ~ U C I E , County.
• 7)
Florida. permaaenti;.
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i
c~.
~i..,,. _ - s
<G
:y
o ~ {
r~[1.YiY Ft~Q`O IAIaAM)
Sworn to and subse:,bed befome me .this ~ day of .
9
- ROGER PO I TRAS. GLERK OF G IRGUI T COURT
ST. LUCIE COUNTY, FLORIDA _
•
BY: '
EPUTY t.ERK
a~321 p~E2116 .