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Declaration of Domicile and Citizenship
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TO THE CLERK OF THE CIItCU1T COURT,
ST. LUG I E ~ oOUN't~r. FLORIDA:
This is my declaration oaf Domicile and (.Ytiseaship in the State at Fbeida that I am ~ this d~ is accordance. and in
conformity with Section 222.17. Florida Statutes.
I was former a legal resident of Y4,U~r ,~'/2.S _ N Y - aad I
tC,uy) 18taW
resided at 3 /z J ES.S y ieq i,v E ~ ~ F - However. I have changed nq domie~e to ,
tSe:..taedNasb.r)
and am and have been a bona fide resident of the State of I"'loorida since ~ ~ ~ 9 - ~y of
-19 - and I reside at Z 7 v 3 ~-c~ tE L ,QG /ID
Iea.et..arl,~e.cl ~
. Fc~ T /'~Ek c _ ST . LUG I E qty.
Iab~
aad this stateme~ is to be taken as >Ny declaration ad citizenship. actual legal residence and domidie in the State of Florida.
" IF FOR THE PURPOSE OF ENROLLING ~ IF FOR HOMESTEAD PURPOSES,
CH1lDREN 1N SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
~Cti•L~ i
1980 APR 10 PIS ~ 09
~1E0 !IE .
- ~J.RK C ~
- RI:'ONIO VERIFIED
- 4~~615
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I F'tJRTIIER CERTII~'Y that I will register at my local address when the registration booms reopen, and comply with aU
other requirements d a legal resident of tbi~ State.
! I F~JR1'IiFR CER1'il;'Y that I Gave no intention to return tom former domicde. and I intend to remain in
U C 1 E County,
1(styl
~ Florida. permanents; . •
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sworn to am snbsedbed before me this ~ ~ day of ~ T, P ~ Ear ~ ~
~ GU ilb~R GUR~~g lit
. A.D. i$.,~.SG.~.
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ROGER POI TRAS, CLERK OF G IRCUI T COC~2T
ST. LUGIE COUNTY, FLORIDA
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EPUTY LERK
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1i~329 P~ 571