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a~~larG_:. of Dor~i~~.~ ~i~i~~~~~~~
469465
TO THE CLERK OF THE CIRCUIT COURT.
ST . LUG 1 E _ COUNTY, FLORIDA:
This is aqy declaration of Domicile and Citisenship in the State of Florida that I am filing this dap in accordance. and in
conformity with Section 222.17. Florida Statutes.
I was formed a legal resident of ` • n c~~ ~ M n
~ tl 2. and I '
n n ~ ICtt7) lStak)
resided at ~n` ~ ~ r`~.._\Z ~1 - However. I have changed any domicle to
l8tn~t and Nambar)
and am and have been a boat Sde resident of the State o~i Fbrida since ~ 1,
~_r ~7 ~
_ _ _ 19 - and I reside at y`? n ~ ~a ,r, c~ ~e r A ~ ~ 2 - ~ _ i
_ 18trwt asd Nnmbt) j
ST. LUG I~E
_ ~c~ ~1 ~ c ~ o _ County. F~o~ida.
Iexe7)
and this statement is to be taken ss my declaration of eitir~enship. actual legal residence and domic7e in the State of Florida. i
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THIIEIR NAMES: `
ItECO~+.: ~F.,r 1.
4 (,9465
~ I FURTHER CERTIFY that I wr71 register at my local address when the registration books reopen. and comply with aU
~ other requirements of a legal resident of this State.
I FURTIlER CERTIFY thst I have no intention to return to my former domicile. and I intend to remain in
-~~„-t--S~- U C 1 E .County.
k (Cit7) '
~ -
Florida. permanenti; . ,
~ CDU
U• :C
~ _ (Naas) ~
V~•F ~ :lei IP.d~. O!. ~ / _ ~ V'F
C~LI/iT. F~~~~ ) ltl ( ~ Q Yl C~ •P t" y
l (Addrw)
~ Sworn to and subsen'bed before me this ~ day of ~O C'~ t' 1-1 t s' ~ `
.A.D.19_ / /
- ROGER POI TRAS. CLERK OF CIRCUIT COURT
ST. LUGIE COUNTY, fLOR10A .
EPUTY IERK
BROK 322 PAGE - • i