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Declaration of Domicile -and Citizenship
4'7`72'x'4 -
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUC I E ~Uh1TY. FLORIDA:
This b my declaration d I)omidle and Citisensidp is the State d Florida that I am SHag this dq in aooordanoe. and in
confamitp with Section 222.17. Florida Stagtea.
I was f rm= a kgal resident oI ~ ~ I
Q ! T Ic~l Is~aw
resided a! ~ . Aowever, I have clanged ~ domicils Lo
18t:e~t asd Nomba~
and sm and have been a bona resident d the State d Fbrida since ~ ~ d
_ 1! ~ Q , and I reside at ~ O ~
_ (8tie~t aed Naesbrl
` ST . _ L UG I E Cowit~, )!'bride.
IacT1
and this statement b to be taken as my declaration d citisenship. sctual kgal residence and domIdk in the State d Flarlda.
if FOR THE PURPOSE Of ENROLLING If i0R HOMESTEAD PURPOSES,
CHItOREN IN SCHOOL, PLEASE STATE PLEASE CHECK: t---~-~
THEIR NANESZ
~ggp f E8 27 ~
ftt_EO_!'NC~£u~Y
flA.
S
ROGER
POITft~S
ClE1tK CIRC017 CO
~FIFD
4'T~'~4
I FTJRTHER CERTII''Y that I w~71 register at my local address wbea the registration boob reopen, and comply with aD
other requirements d a kgal resident d this Stets.
f I FURTHER CERTIFY that I have ~ intention to return to m~ forme~dom~7~e. and I intend to remain in
~ . ~ ~ County,
(C9t71
Florida, permanenti,r•.
~
I ..tiv_ 0/1
Sworn to and snbseribed before me this °2 ~ day d ~~t'-Q-
~ Q
a' i.,1~.2veu.y . A.D.18,3~~-:- (~olwA Rd fir. 0 ~ B R i e nl )
\ 3eA TR; ce 1- o ?~RieN
ROGER POI?RA$, CLERK OF GIRCUI T COC~2T _
ST. LUGIE COUNTY, fLOR1UA
BY s -
EPUTY LERK e~e~ p~
. ~ B~Ic~V P~ alJ7