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Declaration of Domicile and Citizenship
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TO THE CLERK OF THE CDtCUIT COURT.
ST. LUG f E ppU~. ~,O~A; ~
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This is ~ declaratioo d DomieOe and Citisenship in the State d Florida that I am fling this dad in aooordanoe. and in
oonlo~rmitY with Section 222.17. Florida Statutes.
I was formerly a legal resided d ,b,~/1 _ - cd Y 4 ~C and I
resided at ~ l ~ ~ ~ R i ~ ~ ~ - However. I have changed mf domieRe to
18tre~! gad Namb~r)
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and am and have been a bona bde resident dthe State d Florida since dal d
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CG 1 y- 2 a , lg,~
0 and I reside at ~ 9 S C
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~ , Isv..c.~a Ttsme.rl
,1` /l c r_ ~ ST . LUG 1 E Count. Florida.
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and this statement is to be taken as ml declaration d e3tiseaship. actual kgal residetoee and domieOe in the state d Florida.
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IF FOR THE PURPOSE Of ENROLLING If fOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR MAMES: j ;
~RA~ %n (r L gal ~
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Cv~R~•~ t ~ ~.~aC~t 49'7168
- !9$0 AUK 25 A~! ~ 2
FILLL' ati'C F[ CONOFO I {
SLlUC1E COUN f Y. it A. i
ROGER p01TRAS
CLERK CIRCUIT COURT
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I FURTHER CERTIFY that I ~ register at m~ local address when the registration boob reopen. and ~mPb with aD
other re9nireme~s d a legal d this State.
I FURTIiER CERTIFY that I have no iM,catioo to rttura tom former domiede. and I intend to remain in
_ U C I E , Connt. f
Florida. permaneau;.
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s.vorn to and subaeribed before me this a a dad d
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ROGER POI TRAS, GLERK OF C IRCUt T COt~2T
ST. LUGIE COUNTY, FLORIDA - -
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BY: . ~
EPUTY LERKLERK ~ `
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