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-Declaration of Domicile and Citizens~iip .
472315
TO THE CLERK OF THE CIItCUIT COURT.
ST. LUC 1 E AUNTY. ~,p~~;
This is m7 declaration of DomicDe and Citisenship to the 8taLe at Florida that I am Slim this daT in aooordaaos. and is
conformity with $eetion ZE2.17. Fbrida dtatntea.-
I was fonaed a kgsl resident at ,(~~lt~~d.e, and I- .
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resided at,E~X,.~.~,Z1'~--~ -However, I have changed nU? domici3e to
(8tetwt aad Namb.rl -
and am and have been a bona Sde resident oaths State adF7o~rida since ~T~ ~ ~9 7~: /S~da7 ~
l7l_^ C'-. .19Z~.. and I reside at ~ .
aadNes~
~ p _ ST. LUG I E Count. l~lorida. -
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and this statement is to bs taken as my declaration of dtizenship. actual legal reaidence and domia7e m the 34te of Florida.
_ tf POR THE PURPOSE OF ENROLLING ~ IP FOR HOMESTEAD PURPOSES, ~
CHILDREN IN SCNOOLs PLEASE STATE PLEASE CHECK:
THEIR NAMES: -
- ~ f980 JAN I 1 All I1= I0
- _ - F~~~o ENO Rico
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• RECORD VERIFffO
- - - - 4'72315
I F[JR1'IiER CERTIFY that I wdl register at my local address when the registration books reopen. and ~p17 with all
other ragnirements of a legal resident of this State.
I FURTHER CERTIFY that I have no inteation to return to my former domicile. aad I intend Lo amain in
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Florida. permanenci; .
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Sworn to and subsen'bed before me this day of
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~J RN d AR , A.D. is.~.:.
ROGER P01 TRAS. CLERK OF G 1-RGU t T COt~2T
ST. LUGlE COUNTY, fLOR1DA -
_ EPUTY LERK ~e~
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