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Declaration of Domicile and Citizenship
49r72i7
TO TA)r Q.ERR OF Tl~ CIItCUIT COURT.
ST. LUG 1 E pp~y, ~,O~A;
Ibis is m~ declaration os Domie~7e and (~tti=eenship in the State o! Fbrida that I am filing this d~ in aooo:danoe, and in
oonlarmit~ witb Section 222.17. Florida Statutes. n - ~ '
I was lormerl a legal resident d~`Q-~ ~ ~ ~ ~ 1. ~ ~ ~ and I
^rr `tCtt~) ~ IState)
resided at S'} . ~ _ Qc~ l.~ \ t ~An ~ ~ - Aowever. I have changed m~ domide to ,
18a.~t avd NombK)
and sm and have been a bona fide resident otthe State of Florida since dad o!
19 ~ and I reside at'~14 1\ t~.f11~QI` ~r'Ay2.' ~r A ~ ~e.~ ~k.
- 3 e`A7C ~~S ~ ~ ~ ST . LUG 1 Esa«c.aa IQombr)
~ ~ e-~~ _ ~ ~ ~ _ Conng. Florida.
tab)
and this staument is to be taken as m~ declaration of dtiunahip. actual legal residence and domia7e in the State o! Florida.
IF iOR THE PURPOSE Of ENROLLING IF fOR HOMESTEAD PURPOSES, {
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES: _
~'Rrl ~~o ~ ~c~e_ plc.
~~r ~o~. J\~,~,r,~ S~~ rye. 49'721'7
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Al1~ 25 1lt~ sl= 55,
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_ fIIEC ati@ PECORDLO
s R0~6ER
POITRAS~~
CLERK CIRCUIT COUR,ITy~
_ : AtCOR[! \FR~rtFD.. _`i. sri
i I FURTAER CERTIFY that I w~ register at m~ loeil address when the registration boobs reopen. and oomph with all
I~ other regniremeMs of a legal resided at this State.
I .
I FIJIITHER (:ERTII~R that I have no intention to return tom larmer domicile. and I intend to remain in
U C 1 E _ Count.
~ _ ICa<~)
a
Florida. permanenu; .
w ,
.
~.~t- . 3 C3 X35
~ S.vorn to and sabam'bed before ace this ~ daj o! 7~t _ ~ t~C Q
•
A.D.1 Q
. San, ~ c, e. ~,nG e~
ROGER AS CLERK OF CIRCUIT COtdF2T f
ST. LUGIE COUN?Y, FtOR1
- - BY:
EPUTY LERK
a~~337 ~~E 715 - • _.~.i~J .