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Deciarat~on of Domicile and Cit~ienship
481082
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUC 1 E COUNTY. FLORIDA:
This is my declaration of Domicile gad Ctti:eastip in the State of Fbrida that I am filing this day in accordance. and in
conformity will, section x.12.17. Florida statutes. _ S 3 G
I was formed a legs] resident of l ~ ~ and I
_ 1(~ty1 1 )
resided at O S ~ ~ ~ However. I have changel domicfie to
ISteMR asd NmDsrl
and am and have been a bona fide resident of the State of Fbrida since ` ~ S day et .
/ 1
~ G~ ~ 19~ and I reside at l V ~ U 1- 1"~
(IItTMt sod Nambr)
~ ~ l ° _ 17 ~ ST . L UG I E County. Florida,
labs
and this statement is to be taken as my declaration of eitiunship. actual legal residence and domia7e in the State at Fbsida.
• ~ IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
tH i t.DREN i N SCHOOt., PLEASE STATE PLEASE CHECK:
THEIR NAMES:
- _ ~P~ I~R 27 P!d 2~ ~ S
sf !I#~ rOiTRASA
- Aarc ~7_~N~~
RECOR, VER1~lETf._
I FURTHER CERTIFY that I wt7l register at my local sddress when the registration boob reopen, and comply with all
~ othler requirements of a kgat resident of this State.
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I FURTHER CERT'II''Y that I have no intention to return tom former domiea7e. and I intend to remain in
' U C 1 E ~ ~ty~
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Florida. permanend; .
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. ~oioa. - l9-J- l~
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Sworn to aad~n 'bed before me this ~ day os ~ h 1 S 0 x
c~ N
-f ~i A.D.19~.
ROGER POI TRAS, CLERK OF G IRCUI T COtdFtT
ST.~LUGIE COUNTY, FLORIDA
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8Y:
EPUTY LERK i
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•AGO Form 7] -22