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Declaration of Domicile and Citizenship
483159 ~ .
TO THE CLERK OF THE CIIZCUIT COURT. t
1
ST. LUC 1 E oOUNTY. FLORIDA:
TMs L mT declaration aI Domicile sad Cltiseaship !n the State of Florida that I am filing this daT in aooordaaos, and in
o~farmitT with Section ?,2g.Y1. FloriCda~Statule..
I was for er a legal rasWent os T A 1 NT E ST , ~ ~ lC~ ~ IBC and I
141 18tsta)
resided at ,Z ER~ -However. I bave changed mtr domid7e to
(8tewt sad N~¦Mrl
and am and have been a boas fide resident of tbs State of Florida since Q S
l da,T of
'i~r ~
Ap~j,l-- .18~ and I reside at t9'i~ 3 _ 1J~? ~'E5.
leti+~t asdIiasba)
. ~i rc12~-'~c ~ ST. LUG I E C~nnb.
lab?t
and this statement is to betaken as nu declaration of eitisenship. actual legal residence and domidb in the State of F7arida.
i
" IF FOR THE PURPOSE OF ENROItfNG IF FOR HOMESTEAD PURPOSES,
CHfIOREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEfR NAMES:
~ APR 16 AM ~ 3S
_ Eo I~cTOII~
SEjK~R PTRASA~ ~
KERK CIRBlNi
R[CR1tR VERIFICI).:_._
483159
I FtJRTHEB CERTIFY that I w~71 register at mT local address when the registration books reopen. and oomplT with all
other requirements of a legal resident of thi, State. ~
I FURT>~R CERTTFY that I have ao inteatioa to return tom former domicde. sad I intend to remain in ' `
- - - - - - - U C 1 E _ , CountT.
(Qty) -
Florida. permanensl; .
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o f F~ _ i E~ZC~'
f
` ~ (Adder)
- Sworn to and subsrn'bed before me this day of r~..0 ~t 17 pt
ROGER P01 TRAS, CLERK OF G IRGUI T CdrdFtT .
ST. LUGtE COUNTY, FLORtOA ~ -
' .
- 8Y: cS~
EPUTY tERK
BO
K P~GE~~~
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