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D~claratio~ t~f DQrnicile end Citi~~n~hip ~
4'43'70
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TO THE CLERK OF THE CIRCUIT OOUIiT.
ST. LUG 1 E - ~ COUNTY, F'I,ORIDA: .
Tl~ IS ~ declaration of Doa3eBe and Qitiaenship is the Stste of Florida that I am 6ting t>tb dsJ fn aooordanos, sad in
oonfcrmitT with Section ~.M. >~lorida Statutes.. t
I was f ~r ~a legal rerideat of Tn~-..a - . • ~ - and I '
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r~esided u 3.? 9 - However, I have ebanged ~ domicDe b ~
~ • (BteNt ash I~lesDal
and am and Dave been a bona fide resident of the State atFlorida since ~ ~
-19
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O _ and I reside at 2.~ F.•C~....~
02°.~.~ - - ST. LUG 1 E
i~ CouatF, Florida,
sad t>nb statement is to be tsken as aqT deeLration oQ~ dtienship, sctnal legal residents a~ domicile in the State at Florida.
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IF fOR THE PURPOSE OP ENROt.LING _ - IF FOR HOMESTEAD PURPOSESi -
CHI~DREN IN SCHOOIe PLEASE STATE PLEASE CHECKS ~ ~
THEIR NANESS
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- ~.~r°~..~ ~ ~ ~r i ~ Xi_ oo_..~__ ~ 19E0 JAN 30 ~ ~ I~ 03
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- ~.Fw ~ _ _%y. _ ~.c~-?~ Alts FE COkDEO
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I FIJRTAER CER1'1FY that I win register at m~ local address wb~ the registration boob reopen. sad eom~ with all
other regniremeats of a legal resident at this State. -
I FURTHER CERTIFY tbat I Dave no iateMion to return to faamer domie~le. and I intend to raeaain in
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Flora:, m~,-. ~ ~ -
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Swann to and snbecn'bed befa+e me this ~ ~ day a[ ar'~ ,y~„~~' ,
A.D.1 ~ ~ r - - - '
ROGER POITRAS. CLERK OF CIRCU{ T COtditT -
ST. LUGIE COUNTY, FLORlOA - -
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EPUTY LERK
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AGt Form'i.~~