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Declaration of Domicile and Citizenship .
4'72665
TO THE CLERK OF THE CIItCUIT COURT.
ST. LUG 1 E COUNTY. ~,Og~A;
This k ml declaration of Domie~ls and CItiseaship in the State of Florida that I am Lilian this daT in aooordanoe. and 6n
conformity with Section 222.17. Florida Statutes..
I was former a kgal resident of r p I e. rr . P . ~ F IQr L~j(1 and I.
IRtSI tst.al
resided ac I oGb l ~(1 f 1 h r P C~ s1 l~~l P- - - However. I bav. changed mIr domiule to
(strNt and Nemb~rl c aG , -
and am and love been a bona Bde resident of the State of Fbrida since ~ ~ - 1~`1 u~t ~ day o[
~`o?~.~-~ 15`t-h ~
I9_~. and I reside at ! CiC: i': r 1 hhP_ n fl ~ ~~e _
_ (SttMt asd N®eb~rl
F + P. _rr _ _ ST. LUC 1 E County Florida, .
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and this statement is to be taken a, my decLntion ~ citizenship. actual kgal ravdenoe and domie~le is the State of Florida.
IF FOR THE PURPOSE Of ENROLLING IF FOR NOMESTEAO PURPOSES
CHIIOREN IN SCHOOt.s PLEASE STATE PLEASE CHECKS
THE{R NAMES:
19$0 JAN 15 PN ~ G 9
- fKEO AN RECOk0E0
SY.EUCIE ~Q~TY FlA
- _ R~aER Poi?RAS -
` QEAK CIRWIt COURt~
` IIEZ'RID VERIFIf D_~~
- ~ 4'72665
I F[JRTHER CERTII~'Y that I wt71 register at my local address when the registration books reopen, and complT with all
other requirements of a kgal resident of this State.
I 1''URTHER CERT!>!'Y that I have no intention to return tom former domicile. and I intend to remain in
~ U C 1 E ~ County.
((Std)
Fbrida. permanentl; .
1..-~c-•~.....~~.
f~' ~
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U ~
' 1 lNam~l
Sworn to ands tore me this day of ~ ~ = ~~T~u.c~ d' ~t -
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fI•IVV Q, R ~ . A.D.1~.._- GoSit! E
ROGER POI TRAS. CLERK OF C IRCUI T COf~2T
ST. LUGIE COUNTY, FLORIDA
8Y: . ?y-~.
EPUTY LERK e~~ -
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