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Declaration of Domicile and Citizenship
483050
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG i E COUPITY. FLORIDA:
This is IIv? declaration of Domidle and Cftissnship in the Stets of Florida that I am ~S this dq is aooordanos. and in
ooniormity with Ssd3on 222.17. Fbrida Statutes.
I was form a legal resident o1 S ~ n 5 ~d - _ 'M - and I
II ~ lpty) 18tats)
resided at~~ ~ ~ ~ -'o ~ 1 ~ T . - However. I have charged m,T domidle to
18trwt sad NasbR)
snd am and have been a bona fde resident aR the State of Fbsida suxe ~ ~ day at
l, 1
1912. and I reside at / ~ J'10 ~ ~ a n ~ ~
(8trwt sad I1sb.d
ST. LUG I E mod,,
lClty)
and this statement is to be takes as ~ declaration of eItizenship. actual legal rssidenos sad da®ieils in the Stste of Flaeida.
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" IF FOR THE PURPOSE OP ENROLLING IF FOR HOMESTEAD PURPOSES,
CHIL.OREN 1N SCHOOL., PLEASE .STATE PLEASE-CHECKS
THEIR NAMESS
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• i9~ IIPR 15 1~K il~ 06
ST tY. FE A.
• POITRA~
AfJIK C~gHT COWtT
RI~# VERIFif. @_
483050
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I FiJRTHER CERTIFY that I wi71 register at my local address when the registration bode reopen. and comp), with all
other regnirementa opt a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domieti7e. and I intend to remain in
T' -
_ ~ ~ . ~ v.. ~ ~ _ County .
(~q)
Florida. permanents; .
,t
. , -
Swore to sad sn~before me this ~ ~ day of
3 I
e
ROGER P01 TRAS. CLERK OF C IRCUI T COtdFtT _ ~e
XAt~ IeeN 3
ST. LUGIE COUNTY, ftOR10A
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BY S ~ ~uQQ~~ ~
EPUTY t.ERK
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