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Declaration of bomicile and Cititenshi
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4'71658
TO THE CLHRK OF THE CIRCUIT COURT.
ST. LUC ! E COU>~y, FIARIDA:
This is my declaration of Domicile and Cltisenahip in tbs State of Florida that I sm filing this day in accordance, and in
conformity with Section 222.17. Florida~S~t~at~u~t)es. ` \ s
I wan forme a legal resident ai _L1D Y'L~ t' ~Q~C r', N e,b ~ I
((St7) 18tatd
resided at ~ o~ ~ ~i 4~~ ~ However. I have changed my domiak to
18terat and Hua>bK)
and am and have been a bona fide resident of the State of Florida ainoe ,~,7 ~ _ D ~ dad ~
t; c , -19.~. and I reside at ~n to Il e. ?n _ o , n n ~
(Steast and Numbed
~La~..t P ST. LUG 1 E County. Florida,
1(a[ty)
and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE Oi ENROt.I.INC IF FOR HOMESTEAD PURPOSES
CHIt.DREN IN SCHOOLr PLEASE STATE Pt.EASE CHECK:
THEIR NAMES:
r- Yl ~.P Q
_ X80 JAN -7 PN 12: 13
F) Epp ANcc RECOk0E0
ST.~UC~,F~CO~INTY. FAA. s
DM b .r.
CIERK CIRCUIT 0 ~T
" RECCIIn vEaiFi~n
4'71658
I FURTHER CERTfFY that I wdl register at my local address when the regiatntion books reopen. and comply with all
other requinmenis of a legal resident of this State.
I THER CE TIFX that I have no intention to return to former domicile. and I intend to amain in
UCIE
(City) .County,
Florida, permaAen[l
j .
3
1,~~'~~~\\\
~QU~~
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~~~-l,,'~.~~.'~~'"F ~n'^ aID~ ~ ~ 1,
( ) _
Sworn to and subscribed before me this ~ day of p~ _ ~ .11 C ~
~Llr~ ` .a~~...r~ Q O i
A.D.19_~!
ROGER_ P01 TRAS. CLERK OF C IRCUt ~ CO~dF2T
i
ST. LUG i E COUNTY, FLIJR 10A ~
_ ~
BY: }
1.. -7 t
a
EPUTY LERK
- 6(1~K ~i~G•~ PiGf