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D~clara~ion of Dornicil~ and ~i~i~~nsi~i~
4'T7$19
TO THE CLERK OF THE CIRCUIT COURT,
ST. LUG I E CovrrrY, FLORInA:
This is rq~ declaration os Do:nicIIe and Citlsensltip in the State oI Florida that I am Sling this dq in accordance, and in
ooniosmitj with Section 222.17, Florida Statutes.
Iwas formerly a kgal resident d 'y ~~s N~~ F ~ - C ~ and I
((;A7) IStaUI
resided at ? ~f / t+-i it.' . . However. I have changed may dr;,a.:~s LQ
(8t~es1 aad Nambe) `
and am and have been a bona Sde reaident of the State d Florida since ~ ~ 1 ~ ! g / da,T d
~t,~-1LCl.I~~? ~ ,19
p
- and I reside at 4$' I ~ ~4 S [.t L~ ~ ~ ~ j,/~ D I~
(8tnst and Nambarl ~
5'Z- L.1-~ ~ ~ ST. LUG 1 E Count, Florida.
labl
and this statement is to be taken u m~ declaration d eltiunship. actual legal residence and domica7e in the State d Florida.
IF fOR THE PURPOSE Of ENROLLING Ii fOR HONESTEAQ PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NANESS ~~1
19c0 NAR -3. Af•, ~9
• Fi.Eu ' z CU~L~F.~
ST.LUCI~ CCUHTY.fLA.
ROGER POfTRA5
CLERK CIRC~.NT C
fi~~:''7 ;rrn~'
_ 4'7'789
I FURTHER CERTIFY thst I w~ register at m7 local address when the registration books reopen, and eomp~ witb all
other requirements d a legal resident d this State.
I FURTHER CERTIFY that I have no intention to return to mT former domie~7e. and I intend to rtmain in
T . Ut 1 E . Couat.
(mil _ -
Florida. permaneml;-
i
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~'1
- i -
Sworn to if~ItN befora me this d~-d- ~ /J'tt~~ S ~ L/1,~ / ~ f f~i - ~
ROGER P01 TRAS, CLERK OF C 1 RCU 1 T COtdItT ,(~~JNA ly, Ni 1
ST. LUG I E COUNTY, f LOR t OA
BY: -
~TEPUTY JERK ~ -
3
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