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Declaration of Dom~c~le and Citizenship
4'78600
TO THE CLERK OF THE CIBCtJIT OOUAT.
ST. lUC 1 E ~pU1VTfC. ~,p~pA; _
TbL L aoT declaration o[ Domidk and CitisenshIp In the Stste of Flortds that I am Sting this dq in aooordanos. sAd iA
oonformip with Section 228.17. Florida 3tatutee.
I was formr a legal resident d - t R u E R E ~ - ~ ~ ~ a~ I
(Ciq?1 tetaW
resided at - o ~ • N , ~ H_+++rever, I have ebanged a~ domidls to
t8tie.t aad Nam~l
and am and have been a bona Sde reddent of the State d Florida since -tom dy ai
r~ -19
gD
- and I reside at ~ 1 14~ J70 )p 1~.°. w~ ~?n ~ d
- (lit aadNambstl
'P7: i;~. LLr°,~ ST. LUGIE
tav?
and this statement is to be taten as nq declaration of eitisenship. actual legal residence and domicDe is the State o[ Florida.
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IF iOR THE PURPOSE OE ENROLLING IF FbR,~HOMESTEAD PURPOSES,
CNILOREN IN SCHOOL, PLEASE STATE PLEI~SE CHECK:
THEIR NAMES: ~
~AuESCF) RA„yrE Cef?.u~bl.
r '
-1980 MAR -7 AM ii= 24
- A
1!f-0Mr VEBf/
- 4'78600
I FURTHER C~'IFY flat I wiU register at ml local address when the registration boob reopea. and oompl,T witb all
other n9nasmeats ai a legal r~eside~ of this State.
I F'tJRTHER CF.R1'IF7t that ~ I have no intention to return to m~ former domic~7e, and I intend to amain in
- _ ._LUC 1 E _Connt~
Florida. permanentt,•.
~ ,d ,,ice/~ -
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r-
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Sworn to and snbecsibed before me this daT of ~ ~ ~ R. , `~~:°s - ~ 4
~ .o ~ ~ ~ y ~'1
,
- ci l?l~ . A.D. i$,,.~~
ROGER POITRAS, GLERK OF CIRCUI ~ COC~2T -
ST. LUGIE COUNTY, FLOR4 -
_
BYs -
EPUTY LERK '
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