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Declaration of Domicile and Citizenship ~
480340
TO THE CLERK OF THE CIRCUIT COURT.
ST. lUC I E COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship is the State of Florida that I am filing this day in aooordanee. and jn
conforauty with Section 222.17, Florida Statutes, f
I was fob i legal resident of ~D iZ P.dQ ( _ pct and I
(City) (3tatai
resided at ~ / 1~'tm ~ ~X ~ ~ . However, I have changed my domic~7e to
BtrMt and Nnmtwr?
and am u?d have been a bona fide resident of the State of Florida since ~ day of
~r1~,. 29 d and 1 reside at u'-~ ~ ~ ~ D-
~ 1 (3trMt gad NnmMrl
Pd~° e ~ 3 3~l SG ST . L UC 1 E County, Florids,
l(xtyl
and this statement is to be takeh as my declaration of citizenship. actual legal residence and domie0e in the State at Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOLS PLEASE STATE PLEASE CHECKS
THEIR MANES:
198a MAR 2 I AM ~ 1 T
^ ST
lUC1E
COUMTY.F~A.
ROGER (TRA
' CLERK CIRCIAT Cd1R1~,
RLCt1RR YERIftEI!` ~ ~ -
480340
I FURTHER CERTIFY that I wdl register at my local address when the registration books reopen, gad comply with all
other requirements of a legal resident of this S4te.
I FURTHER CERTIFY that I have no intention to return tom former domie~7e. and I intend to remain in
U C t E ~ County.
((St~l .
Florida. permanenu; .
.~h~
vJ~~ ~ CD~N~~
t :Tj ? G
~-l~ ? -
- ~G 1 ` ~ ,~i 1j'-Z
``T
~ /l A
Sworn to and subscn'bed before me this ~ day oaf ~7~`~i ~ LmP~-~
Gin.-C~-~ A.D.18„ Y
~ ~ ` .
ROGER P01 TRAS, CLERK OF C IRCUI T COt'dRT
ST. LUG 1 E COUNTY, FIOR 1 OA ~ ~ Pr I ~ ~ `r ~ ~Oye iC' ~Y
BY: ~oY'~'a1Ne Fe) ~ ,-dye ~
EPUTY IERK
gci~c327 ~~27'92
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