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Declaration of Domicile and Gitizenshi
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TO THE CLERK OF THE ~ OOUAT. .
ST. lUG 1 E COUNTY. ~-jp~~; .
Thb is aUr deelaratioo d Doa~kile and Cltiaenship ie tM State d Z'7orida that I am IDinS this dp is accardaoce. and m i
oonicrmitT with Section 228.17. Florida Statutes. r
I was f
~ a legal resident d ~O ~ 7~ S M d u 7~1 t/ ~ ' and I
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resided at ~ ~ m E ~ "~R . - He~,.eer. I have changes ~ aomidle to
It)IrNtni~
. and am and have been a bona fideresident d the Stets d Floeida since / ~ dq d
/ ~ _ lg a v - and I rssWe at ~e ~ .5 • 3 7 ~7~
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E,pe F ST. LUG I E
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end this statement is to be tai<en as ap dscLsatiod d dtisenahip, actual legal residence and domielis io the State d Floeida.
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If fOR THE PURPOSE OP ENROLLING IF FOR HOMESTEAD PURPOSES, ~
CHILDREN IN SCHOOL, PLEASE-STATE- PLEASE~CHECKS
~ THEIR NANE8a
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I FtJRT7IER CER1'IF'Y that I will register at nq loal address when the registration boots reopen. and eomp~ with aII
j other regairements d a legal rssidee~ at this State. _ j
I FtJR'1'HER CERTIFY that I have no intention to return tom faemer domia'ie. and I intend to remain in
U 1 E ~ ~ Coantj.
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>~rida, Permanentl,~' .
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Sworn to and snbavibed befoe~e me this ~ daj d f
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R A K OF IRCUI T Ot~2T
- ST. LUGIE COUNTY, fLOR1 ~ -
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BY s .a
EPUTY LERK -
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