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~..;.~,r~rion a~ Dc~c~~icile ~ and Citiz~s•...; r
~Ei893'7
TO THE CLERK OF TIIE CIRCUIT COURT
ST. L UG I E aptly, ~,O~A;
This is my declaration of Domidk and Citizenship in the State of Florida that I am filing this day in accordance. and in
• rnnfora_
pity with Section 222.17. Florida Statutes.
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I was formerly a legal of ~ • - and I
1(~t7 )
'"ended a However. I ba changed my domicile to
f$trNt wd NosbK)
and am and have been a bona fide resident of the Stale of Florida since ~ day ofs
i9 -
19 and I reside ~
• (BtrMt and Nombw)
ST. LUGIE
County. Florida,
ta4)
and this statement is to be taken as my declaration of dtizenship. actual legal residence and domicile in the State of Florida, •
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IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCH001., PLEASE STATE PLEASE CHECK: ~ .
THEIR NAMES:
CLFR~. , ' ~ %;U Rr n
Dec I0 1142 AM'1~
46893'7
i
I FURTHER CERTIFY that I wi71 register at my local address when the registration books reopen. sad comply with aD ~
other requirements of a legal resident of this State. '
I FURTHER CERTIFY that I have no intention to return tom former domiede, and I intend to remain in
U C E County.
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Florida. ptrmanenci; .
f;,OUNT
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~~ECOUN?v.F~. ( ) ~
Sworn to sad su before me ibis ~ day of ti ~ V ~
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~.ce~ .beQ ~ w.n.19_ C ~G~waRd `-~?g,~~ef~ /"/ot~Ul
ROGER POITRAS, CLERK OF GIRGUIT GOI~T 50j S. E• Sea-~1ouSe 1.,1R,
ST. LUGIE COUNTY, FLORIDA
BY:
EPUTY L.ERK
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