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Declaration of Domicile and Citizenship
.4'71394
TO THE CLERK OF THE CIRCUIT COURT. .
ST. LUC 1 E COUNTY. FLORIDA: -
This is mp declaration of Doa4in7s sad Citissnahip In tM State of Fbrida that I am filing this dap in aeoordanas. and is
ooniormitp with Section 222.1?. Florida Statuta• U
I was former a legai resident of - ~ ro o ~ ~ r~ ~Qaw.! J Of k and I
LL ( ~ (8tate)
resided at 5 Y ~ T However. I have changed mp domicile to
IStrsst sad asbed ,
sad am end have been a bona fide resident of the State of Florida since dap of
~e Grw. ~.~,r ,19 ~ q - sad I reside at l ~c102 ~ ~ 1'1~ O yt ~V¢, ;
~orf ~ ~ ST. LUG i EeaMc.oeN~e.~?
Counh. Florida.
ceae,~
and this statement is to be taken as mp declaration of citiunshlp. actual legal residence and domia7e in the State of >r'loeida.
If FOR THE PURPOSE Of ENROLt.ING If fOR HOMESTEAD PURPOSES,
CHIt•DREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
- f~~a-fas I~ a I~~ ~a,,•n.g
JAN -3 11N ~ 55
S~OGER
P0~1~F~
A.
CLERK CIRCUIT T
RECOItt VERIFIED--
4'71394
I F'LJi;'1'HER CERTIFY that I w>71 register at mp local address when the negistntion hooka reopen, and oomplp with all
other requirements of a legal resident of this State. .
I FiJRTHER CERTIFY that I have no intention to return tom former domicile. sad I intend to remain in
. U C 1 E County.
(atpl
Florida, permanen~i; .
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i - t ~ ' IN!~1
. c~.. --'1 ~ ~i 2 s ~ I r I o ~ cwe ~j-~-~~
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Sworn to end
ilbeRx~gdtleYore me this 3 dsy of ~~i-?' ~ _ ~-u C~CR., r ~ 3
_ ,
.J N u ~ R A.D.1s~,Q__ a
ROGER P01 TRAS, CLERK OF G IRGUI T .COt~tT
ST. LUGiE COUNTY, FLORtOA
EPU7Y LERK
• ~ i
~3~'3 P~ 494