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Declaration of Domicile and Citizenship •
4968'74
TO THE CLERK OF THE CIItCUIT COURT.
ST . ~ UG I E COUNTY, r-I,pRID~;
This is ~ declaration of Domkde and Citisenship in the SLte a[ Florida that I am Sling this daT in accordance. and in
oonformit~ wltb Section ?22.1T. Florida Statutes.
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I was former a legal resident of ~ ,n ~ -L~
~ ~ and I
IC'x~) IStaul
resided at T__ - Aowever. I have ehaaged mT domicDe to
18w gad N i
and am and have been a bona fide reaident oaf the State of Florida since ` ~ S ~ ~7 ~
-19_~ and I reside at ~D ~ a /y/~~ ~ ~~y C r
( red Nmb~rt
ST. LUG I E
tatil
and this statement is to be taken as mT declaration of eitiunship. ~adual legal residence and domicile in the State o[ Florida.
IF FOR THE PURPOSE OF ENROLLING IF' FOR HOMESTEAD PURPOSES, j ,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK: ~
THEIR NAMES: '
,~G-'d ~I~TT.9 ~.4~/~ W ~n~Aq+~~'' 19~ Atli 20 P11 ~ 03
`r FILCO RN~ fECOK~O .
ST. IUCIE OU>!1 Y. F L 1?•
ROGER POITRAS
CLERK CIRCUIT CpllRt .
REttP!' vFRIFtFQ
- 4968'74
~ ~
I FURTHER CERTIFY that I w~11 register at mT local address when the registration booiu reopen. and oomplT with all
other requirements o£ a legal resident of this State. '
Y
E I FURTHER CERTIFY tlut I have ~ intention to return to m~ fo~rmler
d~omia'k. and I -intend to remain in
S T. ~ u c t r . Count.
(C5t~1 .
Florida. permanemi; . '
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i~ ~I~ ~
`G`~~ CCpNw• F`'J INam~)
IAdde.r)
~ / -
Sworn t0 and snbscnribed before me that a c, diT of (O ~ Sit (i4 ~ . S • ~ i
_ •
ROGER POITRAS. CLERK OF CIRCUIT COt~2T
ST. LUGIE COUNTY, FLORIDA - -
x
- ~ BY:
~
_ EPUTY LERK ec~~c~ ~ -
- - _ 80()K JJ7 PAGE ~O~ ~ ' .
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