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Declaration of Domicile and Citizenshi `f
p
4'713'8
TO THE CLERK OF THE CIRCUIT COURT.
STs EUC I E COU~Y, yZ,Og~A;
This b ms declaration of Domidle and Citizenship in the State of Fbrlda that I aas Sling this day in aoca:danea. and In +
conformity with Section 222.17. Florida Statutes.
I was f~ a legal resident of „na I
ICiVI ietatd
resided at - ~ ~ ~ 1 t2 However. I have ehsnged nq domic~s to
(8eraat aa~d Nomeael - .
and am a-nd have been a bona fide resident of the State of F'brida sines l~~ ~ dyr at
--,~~.~.,i a~ .19-fAT. and I reside at ~ I ~
' ST. LUG I E
labl Counts. Florida.
and this statement is to betaken as ms declaration opt citisenship. actual legal residence and domicile in the State at Fbcida.
IF FOR THE PURPOSE OF ENROLt.iNC IF FOR HOMESTEAD PURPOSES, {
CHIt.DREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES: '
- ~Z..~ 1 ~7 G't ~ I' D /l G L d s
r-- /
T 3 AK ~ 54
TLEO A RFCTORO£0
~~~PflfTRASA.
IRCIlIT T
R[COlts YERfft~O
~~3'78
I FURTHER CERTIFY thst I w~71 register at my local address when the registration boob reopen. and oompls with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return tom former domicile. and I intend to remain in
_ U C ! E County.
((:~t71 _
Florida. permanen~l; . _
t
. • ,COCA,, : .
~r 17j S Yv
_ ~ ~ amyl - , /
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Sworn to and subscribed before me this ~ day of ~
ROGER PO I TRAS. CLERK OF G I RGU 1 T COr~Ftt
ST. LUGIE COUNTY, FLORIDA
EPUTY IERK .
8001 PaGE 4s7'