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Declaration of Dom~c~le and Citizenship
- 482553 -
TO THE CLERK OF THE CIRCUIT OOURT.
ST. LUG I E COV~y, gZ,Og~A;
This is mJ? declaration os Domicile and CItisenahip in the State of Florida that I am filing this day in acoordanoe. and in
c~formity with Section 222.17. Florida Statutes. n
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I was forme a legal resident at ~ and I
~ It~7) 18~ats)
resided at , ~
J ~ ~ S ~ C~. Q..f1~' a - - However. I love ehae~ged my domic~7s to
18trNt and N~t»d ~
and am and have been a bona fide resident of the State of Florida since ~ ~7 ~
-19~., and I reside at ~ 3 ~ ..r"" O~ ('Q `7- °.'''t~- ~ ~ 0
leasst and Nasb~)
c~._,e..~,. Cam. } ~o~ _ ST. LUG I E County. F7oeida.
la4)
and this statement is to be taken as ~ declaration of citisenship. actual legal residence and domicile in the State d Florida.
" IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES: _
C~~- Y~ o~--~~ s cAr
_ 1980 APR 10 PM 12~ 21
S R E06ER
I'01 RA~A.
_ di.ERK CIRCIilT n -
ItEfllt>? ~'fRtftEO fj
. ~ 9:82553
I Ft1RTI~R CERTIFY that I wi71 register at ml local address when the registration booms reopen. and comply with all
other requirements oI a legal resident of this State.
~ I FURTHER CERTIFY that I have no intention to return to my former domic~7e. and I intend to re/m~~a~i~n~ in
J ~ ~ L. V Y. L County. -
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Fbrida, permaaentl,-.
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~ couaTy , - ~ . aneJw.u~
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. ~ I ~ ~ 1~AM M t a-~
s ,-;t.:~.'•' ` Q Maros)
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Sworn to and sn before me this ~ a day of - ~ l ` ~ I i.- 2 C % t t- o R 1 f~ A
n _ ' J' A• 1 y tle
l.~o/~-sue . A.D.19~ J s c{. i
ROGER POITRAS. GLERK OF CIRCUIT C0~2T .
ST. LUGIE COUNTY, FLORIDA •
-
EPUTY LERK
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a~ 329 P~ 485 . j ~ •
AGQ Form 71