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~~lnratl~n ~f ~?~ni~il~ anc~ ~!tl~~n~hip
TO THB CLERR ~1r THE C'IIi+CUIT 00UAT.
ST. LUG i E ppv~~ Pzp~pA; '
This is a~ dedaratioa a[ DomieiM aad ~tissnship fa the State at Flos~ids tha I am ~g this dsg in aeoordana. and is
oontosmitT with 8eetion 25.17, Ffoeida $tstat~e. '
I was i a Meal resident at ,l~a~%
~~~J ~ J ~ and I
. (GV1 / ltRsW
resided a / 4~'b Y~ - 8awever. I haw ehaeged o4 domidM to
tlknst aei I~iswDsel -
and am and have been s boos tde rssidsnt et the State d>r7oeid:sins dq at
~ C~"' ~ ~
. i~ X / l - and i reside a
10tevst adN`l~ei
caw
and this statement is to bs tai as np dseLratioo ai dti:eaship, adnal Meal nsidena and domia0e io the State d Floeida.
IF POR THE PURPOSE OP ENROLLING ~f FOR MOMESTEAO PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE tLEASE CHECK:
THE MANES:
' ~ ~
190 F~8 I i P8 2 14
Fx£o ANpC~+~ ~
s ROG PORC~
CLERK ClRpiit C011t - -
Rc'CGt!0 t'ERtFiEQ
~S~
I FUBTHi3i CERTIFY tha I wDl reEister a ss~ bcal address when the :+egbtration books r+sopea, and eompiT with aD
other regnirements d a legal reeideat of this State.
I FURT~R CERTIY•9f that I have no intention to return to faemer domia7e. and I iaead to remain in
_ U t E ~ Coua~,
E 1a41
~ F7oria:.
_ ~
~ ~`~.~~'t'r~ryc
~ r~ y
~ (Nam
t ~ - ~ IA~daewi
j Swoon to and snbeerttied befos+e me this dq of
t a~ . A.D.1~~
RQGER P01 TRAS. CLERK OF C IRCUI ~ COtdItT
ST. LUGIE COUNIY, FLORIDA
BYs
_ EPUTY LERK
f UR ,
BOOKS P1GE1424 i-.