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Declaration of Domicile and Citizenship
49`'149'7
TO THE CLERK OF THE CIItCt1IT OOURT.
ST. LUC i E Cpv~y~ FI,O~A;
This is mfr declaration of Damkik and Citisenship is the State of ~7aeids that I am ~ this daT is acooedanoe. and is
oonfoemitT witb Section 288.17, Fbeida Statutes.
I was i r a legal resident opt ~d.. and I .
l(~71 letataa
resided at~(~ - ~ S3?. 1s _ - However. I have changed ~ domials to
. 18traat and Nrnbad .
and am and have been a bona fide resident of fife State oE>!'lorida since dp aI
lg~.~ and I reside at ~~'a- ~ ~41~ . V ~0.
(sb..c..d I~lae.rt -
- ST. LUG I E C~nnti.
two
and this statement is to bs taken as ap°decaration at dtissnship. actual legal residence and domidle in the 8tats of Floeida.
" IF FOR THE PURPOSE OF ENROLLING IF fOR~NOMESTEAD PURPOSES,
CH I t.DREN 1 N SCHOOL., PLEASE STATE PLEASE CHECK: ~i~
THEIR NAltE3: ~ v ~
r~ ~ 140!! ~ ~S
.VW ..vv
fILE01?NCp~COROEO
ST~L~
I~CPOITRAS A~
_ CLERK CIRCWT LOUR
_ ~ RECORD VERIF~ED_ .
" ~ ~ 49'749'7
it `
! I FtJR'1'I~R CERTIFY flat I will register at m,T local address when the registration books reopen. and compb with aU
other requirements of a legal reaident at this State. -
I FiJRTHER CERTIi•R thst I have no intention to return to former domiei7e. and I intend to remain in
U 1 E . Connt~.
_ lCih)
Fbri<la. permanensl; .
.rte.,.....
V ~ CI!
. Sworn to and sn6ed before me this ~ daT o[
n~
T.•~.•
ROGER"~'P01 TRAS. CLERK OF CIRCUIT COt~ZT -
~ST. LUGIE COUNTY, FL tOA ~ ~ ~
•
- - BY: ~ - .a
EPUTY LERK
AGO Form Ti-?2
_ T