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Declaration of Domicile and citizenship y-•
49'7'613 -
TO ~ CLERK OFTBE CIRCUIT OOURT.
ST. LUG I E Cpv~p~ ~,O~A; .
- This b m~ dsdaration o[ Domidls and (2tisemhip in the.8tate at l`'loeida that I am this daT is aoooedsaoe. and is
• contormitY wltb Section 822.17. >i7orida &atates.
I was fozme a legal resident aI i~ and I .
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resided at ~ 7A L~~.~ _ . ~ - Ho~+rever. I have changed ap domicile to
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and am and have been ~i boas Sde reaide~ ottee State atFlorida since dad d
_.19~ and I reside at ~
- tete..c atl N~l.ei
..1 _ ST. LUG 1 E Co~mt~.>z7oe~ida,
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and this stateme~ is to be taken as ap deelaratioo d dtiaenship. actual legal residence and domie~e in the State d h7orida.
• If FOR THE PURPOSE OF ENROLIiNG If FOR NOMESTEAO PURPOSES
CNILOREN IN SCNOOL~ PLEASE STATE PLEASE CNECKS
THEIR NAMES:
I~EO ~E
~ 27 PK ~ 1 g
FILEQ MC FEO
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COUIt Y. f A.
CLERK~CI+RCIA~T
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49''1613
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I FUR1~ CERTIFY that I wHl:egister at mY k+eal address when the registration boob ieopea. and eompb with aII
other re~rementa of a legal resident ai this State.
I FURTI~it CERTIFY that I have no inteM,ion to return tom former domicile. and I iateaa to remain in
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Fbrids. permanensi; .
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- Swore to and snbsesibed beloee me this ~ daY od
• - - A.D.19~
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NOGER POITRAS. G~ERK OF CIRCUIT COtdFtT
ST. LUGIE COUNTY, FLORIDA
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EPUTY LERK
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AGO Form 7l