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clar~tio~ of Komi i r ~
e c i~ ~~d Ca#~~~ns~~p
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TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG I E COUNTY. FLORIDA: - .
_ Thin is my deelarittinn of Do:nip'!e and Citi:er~ship in the State of Florida that I :m Sting this.dsy in-accordance. and in
R .conformity with Section 222.11, Florida Statutes.
' I was fot-merly a legal resident of _ ~ ~ n e (~Q _ T' t L I,~.,(IT
Sand I
J tCit71 ~ ISM
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resided at _ ~.~o~ ~ ~ _ ~ / ,
f jt~~ ~ L'.ha 0 ~ LL . Aowever, I have ebauged aqy domic~e to ~
ISircet snd Nombarl
and am sad bane been a bona Gde resident of the State oI Florida since Q t Q~S~' ~ day of ~ ~
L Gt)S _-_:19_1.,_, and I reside at lnd ~ ~ . ~~TUA1~14 ~pl°
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_ t3teeat asrt Naab.N
~/D ~ Q_ _ ST. LUG 1 E -
County. Fbrida,
tcxti) -
and this statement is to be taken as my declaration of citizenship. actual legal residence and doauicile in the State of Florida.
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IF FOR THE PURPOSE Oi ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:"
THEIR N/fNES:
S'~p~
RECfMlI VERlF1Ea
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I FURTIiER CERTIFY that I w>7l register at my local address when the registration books reopen. and comply with all
other requirements of a legal resident of this Stste.
I FURTHER CERTIFY that I have no intention to return to- m)? former domitile, and I intend to remain in
U C I E y C~u~y.
(l~ty) _
Florida, permanenrt;.
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& cou~yr/. ~ m ~ _
Sworn to an u ~ Y . ore me this a3 day of
ROGER P'OI TRAS. CLERK OF •C IRCUI f C4tdItT - .
ST. LUGIE COUNTY, FLORIDA - _ '
' BY: .
_ EPt3TY~ERK
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