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Declaration of Domicile and Citizenship N-
4'1585 -
TO THE CLERK OF THE CIIiCUIT COURT.
ST. LUG 1 E - COUNTY. t?'LORIDA:
This is my declaration ~ Domici'le and Citimnship in the State of Florida that I am Sting this day is aecaedance. and in
conformity with Section 222.1?. Florida Statu(t~eps.
I was forme a legal resident of--~ TS~-~ ~ v ~i and I
n ~ lCK7) i81at~
resided at ~ ~ + X ~ a 7 - C- ~ - However. I have changed my domia7e to
(BtrNt aed NombK)
' and am and have bean a bona Sde resident of the State of Floridasince ~ ~ ~ ~ dal of
19~~. and I reside at S / / ~ ce~Q y`- C}' ~
(8tzwt and Nasba)
~ ST. LUG 1 E County.F7a:ida.
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and this s4tement is to be taken Aa ~ declaration of eitisenship. actual legal residence and domicile in the S4te of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMESS -
_ 1990-JAN -4 Phi 3 34
p~LEO AMU FECO?ctkt?
ST L!1_C~fi COUMiY. Ft A.
rcu6kR POITRAS
CLERK CIRCUIT COURT
P.ECORO YFRIFIEO_~~
. 4'1585
I FURTHER CERTIFY that I wt71 register at my local address when the registration hooka reopen, and comply with alt
other requirements of a legal resident of this State.
I
I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain in
U C i E County.
. (GStrl
Florida. permanencl; .
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: Sworn to and su re me thu ~ day of ~ l~~~~ c_.e ~ .
Ntl . A.D.19~._ ~ !?i o der l~. ~R itit s ~~ey~
ROGER POI TRAS, CLERK OF G IRCUI f COtdRT
i
ST. LUGIE COUNTY, FLORIDA
BY: J„~'.
EPUTY LERK
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