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Declaration of Dom~c~le and Citizenship
To~IIE cLERx oFTIII; clRCUrroovRT, X9'7419
ST. LUG I E 00T)NTY. FLORIDA:
Thb b m,T deeLratioo of Daa~ieiie and (2tbsasbip in tbs State ot)<7orida the I am iSing thb dy in aooordanos. sad in
eoatormitT with Section 228.17. Fbeida Statutes.
I was former a legal resident at ~ ~ I
ICit71 18tat~
resided st ~ ~ (g'`r ~ R Nvwavar. I Gave changed nV domicile to
18tn~t a.a I~N~lK? - -
sad am and have been a bona fide resident of tbs State at Florida since 2 ~ o~
18 ~ o . sad I reside d ~ A S ~ R+ 1 IR ~ y'e-
- _ Isa..t..aN..e.d -
~a ~ S`Y' L tl L ST. LUG I E Cwmt~?.)`7oeida.
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and thb statement b to bs taken as m,T deeLration of dtisenship. actual kcal residence sad domidk in the Stets a[ Florida.
IF FOR THE PURPOSE Of ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCMOOI, PLEASE STATE PLEASE CHECKS
THEIR NAMESS
- ~BR~eN~~ ~oe~ ~ ~~i'7419
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~o~ N i~ ~,IR o e K / ~O ' , Y
T SeA ~ l~fl to 2s P!. I~ 40
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_ lXE CIRCUIT C01155RT
RECORD ~'fRIFtF~--------
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I F4JR1'f~R CERTIFY that I will register st mT local address when the registration boom reopen. and ~Pb wKh all
~ other requirements of a legal resident of thb State.
I FURTHER CERTIFY tbst I have no intention to return tom former domicHe. sad I iatend to amain in
~ u c ~ Countj.
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Florida. permanents; .
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Swore to and snbeers'bed before me this b dad of - -
- -
ROG:ER P01 TRASH CLERK OF CIRCUIT COt~2T - -
ST. LUGiE COUNTY, FLORtUA
• • l w ~
EPUTY LERK ~j 1
- - BOOK ` PA6E~~~ ~ .
AGQ Forth 71-?2 j