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' mi it n Citizenshi
Declaration of Do c e a d p
4 ~~.o~
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUC 1 E WUNTY. FLORIDA:
This is m,T declaration of Domicl7e and Citizenship in the State of Florida that I am liting~this day in aoeordanos. and in
eontorntity with Section 222.17. Florida Statut~e/s~ / ~ ,(1 .
I was former a legal resident o[ ~ " ~ " G~ U~ 1r, and I
resided at ~~~0 Z ~ G~ ~Srti/i e w ~ ~ P , However. I have changed m,T domie~e to
IBtrMt aed Nrm~b~rl -
and am and have been a bona Sde resident of the State of Fbrida sinus ~ ~ • ~ ~U' ~
~9 ~-~f
l ~s s ~ ,c~ ~ Z
--Jl•-c.. c.~ 1 and I reside at ~ ,
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~C> ~t5~=+~ Uf~'Gecf.~ ST. LUG 1 E Connt~, Flor;d,,
tar,
and this statement u to be taken as m7 declaration of citizenship. actual legal residence and domic7e in the State at Florida. ~
~
_ IF FOR THE PURPOSE OF ENROLLING IF FOR HONESTEAO PURPOSES,
CNILOREN IN SCHOOL, PLEASE STATE PLEASE CHECK: ~ ~
THEIR NA.NES:
1960 NAR 27 Ply 2 08
S~U
Ct~COUNTY~fLA.
- ~IOGE PQITRA
~FAIt CfRCINT C~INt
~ i'ERIFIEO
3
~y~ ,
4S~V It
t
I FURTHER CERTIFY that I w~71 register at aqT local address when the registration books reopen. and oomplT with aII
other requireme~s of a legal resident of this State.
I FtJRTIiEFt CERTIi•R that I have ,na intention to return to mF farmer domie~7e. and I intend to remain in
~ ~ - JT.1
V61-E--
_ . Count7.
((xt7)
Florida, pernsanead; .
i
_ -
E ' , ~ J • (Name)
y
• iA~TM~)
E Sworn to and subsen'bed before me this ~ ~ dad of .
~ ~ .
! ROGER P01 TRAS, CLERK OF CIRCUIT COC~2T
~ ST. LUGIE COUNTY, ftOR10A
BY: -
EPUTY LERK ~ -
~ g~~ P1,GE
.AGn Firm 7122