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Declaration of Domicile and Citizenship -
4'71.364
TO THE CLERK OF THE CIRCUIT COURT, j
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ST. LUG 1 E COUNT7C. FIARIDA:
This is nq? declaration of Domidk and Citiasnship In the State of Florida that I am ~ this dq in aoooedana. and in
coatormity with 8ettion 222..17. Fluid-. Statutes.
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I was former a legal resident of ~ - and I -
1 (At71 (81aW `
resided at ~ C ~ ~ ~ ~ _However. I have changed nqy domin7e to
- 18trMt sad NamMN
and and have been a bona fide resident of the State of Florida ainoe - a a ~+a¦¦~ - day o[
29 ~ and I reside at a 0 / ~ ,~/J~~~h~.~P - ~-la r~.
~f . /,d ~c~ 18tewR sad N.aibKi County. F7adds.
ST. LUGIE
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and this statement is to be taken as my decoration ~ titisenship. actual legal t+eaidanc6 and domia7e in the State at Florida. -
Ii' FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES,~2 -
lJ.%y/irt ef_~_ .L ~
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~BO JAN -3 AM 9~ 25
- - f EO AKC RECOROtO
S~LUClE CdtglTY.FIA.
R ER PWTRAS
CLERK CIRCIgT _ -
ltECORO NEAtFlEO
4'71364 -
I FURTIiER CER1'IF'Y that I wdl register at my local address when the registration books reopen. sad comply with all
other requirements of a legal resident of this State.
I FURTHER CERTffY that I have no intention to return tom former domicile, and I intend to remain in
_ _ _ U C 1 E ~ - ~ County,
1(Sty _
Florida. permanencl~ .
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Swore to befor+e me this day of ~ ~_,[_.G. t: t ~ ~ -~d _ 3 ~ Y'~o
~ni~~R~/ - A.D.19.~ _ i
ROGER P01 TRAS, CLERK Of- C IRCUI T COrd2T -
ST. LUGIE COUNTY, fLORiUA
BY: -
EPUTY LERK - -
- ~ a~3~'.3 P~~E 449 - p