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Declaration of Domicile and Citizenship ~
481164
TO THE CLERK OF THE CIRCUIT COURT.
ST. L UC 1 E COUNTY. FLORIDA: _
_ {
This is m7 declaration of Domicile and Citiaenship in the State of Florida that I am Sling this da,~ in aooor~dance. and in
conformitf with Section 222.17. Florida Statutes.
I was former a bgal resident of 2/--~ ~ ~ I
(t~71 i8~aW
resided at r}~ ~d ~ . However. I have changed ~ domici'k to
IStnat aed Nambae)
and am and love been shores Sderesident ottheState otFlorida since /z t dq of
/,rc. t
.197___. and I reside at ~ 3.r~~ /.~i- y~ /yr~ -r
_ and Nmb~r)
`~'r' ~'r ~ Y ST. LUG 1 E ±
(0141 Connq. F9orida,
and this statement is to be taken as mT declaration of eitisenship. aduai kgai residence and domicile is the State at F7acida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NANES:
!~!R 28 1W ii= 33
~O~CsE~R
P~TRAS~
- ~ 9LERK CUtglIT
48~s4
I FiJRTAER CERTIFY that I w9! register at mT local address when the registration boob r+eoPen. and oomplT with all
other rcgninments at a legal resident at this State. ~ .
I FURTHER CERTJF'Y that I have no intention to return tom former domicile. and I intend to nmaia to
~ ~ U C 1 E . CouMj.
10f~1
Florida. permaneasi;.
. ;;,.:::uiii~~i
.
~ L v
..f .J ~ RJR` • ~ ~i
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sworn to and aubsen'bed before me this ~ da, of / ~i~ ~ ~1 ~ T / ./"tc • 3-3 y~~
~ - ~ ~
. A.D.19 ~
~DN ~.~ANe~
ROGER POt TRAS. CLERK OF C IRGUI T COtdRT
C 1~ a
ST. LUG I E COUNTY, f LOR 1 OA ~ ,G-) a~ I R S. Y
BY: ~
~ ~
EPUTY LERK :
8U
~Vs.~V ~~~L,i.~•ri
AGO Form 7] '