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Declaration of Domicile and Citizenship
482'764
TO THE cI.ERx of THE cmcurr oovRT, -
ST. LUG 1 E IJOUN'1'Y; FLORIDA:
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This is my declaration of Domiei7e and Ckissnship in the State of F9arida that I am films this dq is aceordanos. and in
oflnfarmity with Section 2?2.17. Fbrida Statutes.
I was form r a legal resideat at _ ~ ~
II~t71 1~
resided at - However. I have changed nq~ domieIis to
lenwc ~ Nsabr)
and am and have been a bona fide resident of the State of Florida since ~ ' n~~ ~ ~
19__, and I reside at ~l ~ 3 ~'~`e+r' A~ tTn ~ ~ ~ ~ ~
(8trwt sadNasba)
~ 6~}- ~ ~ C-~ _ ST. LUG I E ~.>z~~
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and this statement is to be taten as my declaration of eititenship. actual leB+d residence and domia'le in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL; PLEASE STATE - PLEASE CHECK:
THEIR NAMES:
- - ~ APR 11 P!1 2~ b5
EO f~~~1cI~
~OIT, RAD .
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- 482'764
G I FURTRER CERTIFY that I wSl register at ml local address when the registration boots reopen. and eompb with all
other regninments oI a legal resident oaf this State.
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~ I F~JRIZTFR CERTIFY that I have no intention to return to my former domic~7e, and I intend to remain in
~ ~ E ,County.
(ISt7)
Fbrida. permanend; . f
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- Sworn to and subscribed before me this ~ day of ~ ~Q~- ~
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R A C R K OF CIRCUIT COtdFt T -
ST. LUGIE COUNTY, FLORiOA
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EPUTY LERK
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