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Declaration of Domicile and Citizenship
4843'73
TO THE CLERK OF THE CIRCUIT COURT.
ST . LUG 1 E COUNTY. FLORIDA:
This is rqy declaration of Domicfie and Citisenship in the State of Florida that I am filing this day in aocordanee. and in
conformity with Sectioa 222.17. Florida Statutes.
- I was fob a legal resident of X~~~J B-~~ ~
.~C~ ~
sL~ ~:1J',i-- z s ' ~ I
r lC'k71 IStatel
resided at - .~c-~ t~,1 !t',- ~J( d /L~ li' However. I have changed my domicile to
IStnst gad Numb~e)
7~,.
sad am and have been a bona fide resident of the State od Florida since ~-~I ~Jr c a'~ ~7 day e[
yf
~ 1 r, z t^ L~ _ .19~. and I reside at << / ~-u '
~ ~ ST. LUGIE~~N
County. Florida,
i
and this statement is to be taken as my declaration of dtiunahip, actual legal residence and domiu7e in the State o1 Florida.
_ IF-FOR THE PURPOSE OF ENROLLING IF FOR HONESTEAO PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
(9P~0 NAR 2I AN 46
_ f+~EO ~kc +~ECOUI~te
sr.wc+E cot~ rY ~A:
ROGER P0ITRAS
CLERK CIRCIMT COIMtT
I+EffO+IK VfR1ilEQ
4843'73
I FURTHER CERTII~`Y that I wdl register at my loud address when the registration books reopen, sad Damply with aII
other requirements of a legal resident oaf this State.
I FURTHER CERTIFY that I Gave no intention to return tom former domicde. and I intend to remain in
' ll ~ E County.
Florida. permanents; .
• . C'
iJ ~x~, .G
'rj i~y-~ r t
~G,.' , f'. ~5^~ ~-..OPEC 7- ~ ~..LJ
4--+ ' - -G( -4
~~f eCUar+. F~ Add~rr) -
Sworn to and su before me this ~ day of
~ A.D.18~~
RpGER POI TRAS,, CLERK OF C IRCUI T COt~2T
ST. tUGIE COUNTY, FLORIDA
BY: 1
EPUTY LERK
Bt,l~ •.N;.~ P1~6E~~