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Declaration of Dom~c~l~ and Citizenship ~
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TO THE CLERK OF THE CIRCUIT COURT.
ST. lUG i E COUNTY. FLORIDA:
This is my declaration of Domicile and Citizenship in the State d Florida that I am Sling this day in accordance. and in
conformity with Section 222.17. Florida Stt~atyut~es. -
I was fo=rte a legal resident o! ~ / r-/ 1 Q ~ q~ J ~~Q and I
/ ~ 6 J ' tseatl
resided at ~ ~ -5~~/ U . However. I love changed uU domies7e to
IStewt sad Naafi
and am and have been a bona Sde resident of the State d Fbrida since day d
_ 19 ~ t - sad I reside at . ~ -
• (8tra.t sad NamD.rl
- /F~,{ D ~ Q~ ~ ST. LUG I E County. Florida.
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and this statement is to be taken as mJ declaration d citizenship. actual legal residence and domicile in the State d Florida.
_ IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK: ~ -
THEI NAMES: '
1980 NAR 17 Ail i 1 ~ 2 7
FFILED AND Rf CORDED
- ST.LUCIE COUNTY.FU.
aE~ECINRC
Mi RASrf~
!EC'~6 VERIFIEO_./
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I FiJRTHER CER1'IF'Y that I ~ register at my local address when the registration books reopen, sad comply with all
other requirements d a legal resident of this State.
I F'iJR1~IER CERTIFY that have no intention to return tom former domiu'k. and I intend to remain in
_ U C 1 E .County.
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Florida. permaaenti; .
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Swore to and subscribed before me this ~ day d ~ ~'-~2~ -
n ROGER R01 TRAS. CLERK OF C IRCUt T COC~tT
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ST. L UG i E COUNTY, f LOR ~ OA - '
BY: ~ ~
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~ EPUTY JERK
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BOOK~~ PAGE~6~~ ~
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