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Declaration of Domicile and Cit~zenshi
P
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TO THE CLERK OF THE CIItCUIT COURT.
ST. LUG i E COUNTY, FLORIDA:
This is my declaration of Domicile and CItiseaship in the State of Florida that I am Cling this dq in aooordanoe. sad in
conformity with Section 222.17. Fbrida S~tatu/tes. f~
G7~C~t:~ Il. /C i
I was fob a legal resident of o _ !tx e~~ oru Gt_ -t and I
(Ctt~l Stag
resided at ~ Cu~.h _d y ~ rg~~~. ~..i.....t~
•.~1~;h... L./ Ito~ar$t. I ~ssra rhaaord my d~xnir,`Iw to _
IStraat and Naafi
and am and have been a bona fide resident atthe State of Plaids since h ~N / ~ / g `7~L_ day uI
.19__. and beside at ~ ~ 3 CIL,r~c-,•~~~? Q,~ fTliU f~
(Btnat sad Nambr)
S r. n~u,c~,r: S T. L uG I E Count,. Florida.
tCtti)
and this statement is to be taken as my declantioa of titittnship, actual kgRl teaidenoe ~ domicile in the State dFlorida. - i
_ IF iOR THE PURPOSE OF ENROl.i.lNG If FOR HOMESTEAD PURPOSES,
CHlIDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMESt L
- FiLEO At10'~ECp~r~`0
' S~tO It
tQ1TT~lASA~ f
q.ERK CIRCGIT
• Rf C0flp YERtf ff L~
i
480Sy9 .3
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I FURTHER CERTI>!'Y that I wn71 register at my local address when the registration boobs reopen. and comply with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return tom former domiex7e, and I intend to remain in
7. L u c ~ E .County,
(~cj)
Florida. permanenci,
.
K~.
? V ~ 1•.
- ~ ~ -
- . `-t';-!' (Hama)
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Sworn to and subser?'bed before me this ~.r daj of ~ c„[2 -,L _ , c~'~ ! ~.e
ROGER POI TRAS. CLERK OF C tRCUI ~ COC~2T
ST. LUGIE COUNTY, FLORIDA
-
EPUTY tER
80(~tdlirV ~ ~ ~
AGb Perm 71-?Z