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Declaration of Domicile and Citizenship
4830'7`7
TO TAE CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E COUNTY, FLORIDA:
This is n4y declaration of Domidk and Citissnship in tba State at Florida that I am SHns this day is aooordanos, and in
conformity with Section ?22.17.1:1orida Statues.
I was i~ a legal resident of LO ~ d. _ /~S t'~y ~ ct'~
and I
r 1C~ty) 181at~ -
. resided at ~"~a
~ f~ . ^~~r ~ - However. I ha changed nU? domiu7e to
1tli~~ ~ 1'IYObK~ 4
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and am and have been a bona 5de resident of the StaLs of Florida since ~y ~
~ .
19._, and I reside at
sad NmDKI
_ ~e. f-.~:~ ST. LUG i E County.Fkeida.
tAbl
and this statement is to be taken as my dee4ration a[ eitisenship. actual legal residence and domidle in the State et Flceida.
,
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' IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHIIOREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
T-HEIR NAMES:
- Aso ~ i s ~ ~i: ss
s~
- _ ~LE!•K Cpt~ COURT
RE66R0 ~KRiFtEt'_._.z~-~-
- ~830'T7 i
-
I FURTHER CERTIFY that I w~71 register at my local address when the registration books reopen, and comply with all
other r~egnirements of a legal resident of this State.
~ I FURTHER CERTIFY that I have no intention to return tom former domir~7e. and I intend to remain in
U C I E _ County,
/C
_ Florida. rman~ntl~
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p.
`?c~f CCt:NiY.fc~.
/ (A~~MS~
Sworn to and snbsen'bed before me this ~ S day of 6 90_~ SC 15 aS'7%c~t1 ~ ~'t~'kR-
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C~p~tc:C.- . A.D.1$~.~.
~IANCe ~ PRi•eS7
ROGER POI TRAS. CLERK OF CIRCUIT COCdRT ?QaN PR;es~
ST. LUGIE COUNTY, fLOR10A ~ -
- BY: (~u-cL.a ~c~~ ~ ~
EPUTY t.ERK •
- ~ -
~(bKJ~ P~GE~LI~ - i • . ~
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