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Declaration of Domicile and Citizenship -
TO THE CLERK OF THE CIRCUIT OOURT. .
ST. LUG 1 E 49~'~2
oovN'rst. FLORIDA:
This is ~ declaration d Domie7e and (Stiaeaship m the State d Florid: that I am itling this daT is aooord:noe. and in
oonlormit, with Section ?22.17. F'jorida Statutes.
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I was former a legal resident d ~ U.S /t P G-0 /V ~ ~ ,G ~ G /q /1 / and I
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resided u ~ SA /V ~0 ~ D s ~ . _However. I bse changed m, aami~,-le to
IBt:Mt.aa H.ve.rl
and am and have been aboas Sderesident dtbeState d Florida mace - ~ a ~ ~ ~ dad d
19_.. and I reside at ~ 3 D C ~/e ~ R ~ L C ~ D~
IBteMt s~A I~1
„~e I _ S % L. r/ C / P ST. LUG i E Co~mt,~ Florida.
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and this statement is to be taken as m, declaration d ritisenship. actual legal resideaoe and da~mia'k in the State d F'jorida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCNOOI, PLEASE STATE PLEASE CHECK: `
THEIR NAMES:
Igo ~ 0 ~ . T~ 8 e ~2
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T A n~ e s R, ~ ~ A n. c y ~stt a~~ 25 PN ~ 29
' ` C /•N D ~ [7 A N F IIEC kt+Y F: C0i<GF O
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- M A R S >5/A L L ,6 L A~ e y aEtuc cttnutT ca:Ri -
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I FURTHER CE1tTIFY that I w~ register at mT heal addsesa when the registration books reopen, and oomplT with aD
other requirements d a legal resident d this State.
I
I F[7RTHER CERTff'Y tbst I have m intention to ntmn to loaner domia'le. and I intend to remain in
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E Florida. permanenti; . -
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s.~oi~ t4 ana~au - - - = lore me this aa, d PO ~ S ~ 4J/ L / P C A
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ROGER POI S Gt_ER OF CiRGUI T COt~2T
ST. LUGIE COUNTY, FL 1DA - - .
BY: ` z ~
. E P UT Y L E R K
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