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Declarat~on of Domicile and Citizenship
4'TL499
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TO THE CLERK OF THE CQiCUIT COURT.
ST. LUG 1 E COUNTY. FLORIDA:
This is my declaration of Domicde and Citizenship in the 8tats of Florida that I am Sting this day in accordance. and is
conformity with Section 222.17. Florida Statutes.
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I was formed a legal resided ` ~ I
resided at ~ l•'~ /Zi-•.•~ (~t~l - However, I have
changed my domic7e to
(8tewt cad Nosb~r) '
and am end have been a bona Sde resident of the 8tats of Florida since ~V ~
/ .19 n , and I reside at ~9~~
(8ttwt na Nmb~r)
ICUyI
and this statement is to be taken as my declaration of citizenship. actual legal residence and domid7e in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES
CHILDREN 1N SCHOOLr PLEASE STATE PLEASE CHECK:
THEIR NAMES:
r-- ~
X980 JAN -4 Ak ~ 46
S~ EI
Clit-P-A~Trt A.
giERK CIRCUIT COURT
• lal~e vcRIFIEO_~
4`Tt499
i
~ I FURTHER CERTIFY that I wdl register at my local address when the registration books reopen. and comply with all
other requirements of a legal resident of t6u State.
I FURTHER CERTIFY that I have no intention to return tom former domicile. and I intend to remain in
U C I E ,County.
(qty)
Florida. permanenci; .
I
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. v ~
c Jam,': ~ ~ ! (p
Sworn to and subscn'bed before me this J day of~ !}-s i n
3
V H ~1 J ~k J , A.D.19$
ROGER P01 TRAS. CLERK OF C IRCUI f COC~F2T _
ST LUGIE COUNTY FLORIDA
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~EPUTY LERK cc~ ~ -
800K~~••J PACE
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