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i~e~i~reti~n ~f ~~~i~ile and ~~tizenshi~
. - 4'71112
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUC 1 E CpU~y, ~,ORIDA; j
This is my declaration of Domicile and Citiseaship in the State of Florida that I am filing this day in acoordanee. and is
conformity with Secttoa 222.19. Florida Statutes. -
I was former! a legal resident of - ~ ~ ~ and I
. tCit71 lStatd
resided at ~ - v ~ ~Q~~ However. I have changed my domia7e to
(Ste~at ambaN
and am and have been a bona fide resident of the State of Florida since ~ ~ ~ ~ - ~y °f
l ~vu ,19~ and I reside at _
l3trMt and Nnmbarl
A~ i~.~.%s ~n~ ST. LUG I E County, F9orida,
tC~1
and this statement is to be taken as my declaration of citizenship. actual legal residence and domic~7e in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOME-STEAD PURPOSES
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS r,/,
THEIR NAMESS ~ ~ I
i
- ~ 1919 DEC 31 ltM ii~ i 2
r- - F..~E~.~r t+r~~COkDiO
s~ROGE~
POI~RA~A.
- CLERK CINCtNT LOUR
' R~ yERIFtEO_
4'7'L112
I FURTHER CERTIFY that I will register at my local address when the registration hooka reopen. and comply with all
other requirements of s legs! resident of this State. -
I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain in
_ T . U C (E _ County.
ICa~)
Florida, permanend; .
`.~tii«i~ u~t~~
s~/ ` ~
Swo~ri ' ~ bscrilied before me this ~ day of ~ _z-~ z k'--
.A.D.19~ f 9
ROGER P01 TRAS, CLERK OF G IRCUI T COURT
ST. LUGIE COUNTY, FL DA - -
EPUTY LERK
- g1~3~'3 P~~f 5?-