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Declaration of Domicile and Citizenship ~ ,
SOQ536
TO THE CLERK OF THE CTIi('ZJIT OOURT.
ST. • L UG i E COUNTY. FLORIDA:
This is mT decLration d Domia7s and (~itisenship in the State d Florida that I am Bona this da,Y in acoordaooe. and in
oontormit~ with Section ?2Z.1T. Florida Statutes.
I was former a legal resident of NEW Yy ~ ~ C 1~ ~ • ~ sad I
It~71 18tatel
resided at ~d0 ~ 7 3 ~ - Sowever. I have chanced mT don~de to
(BuMt ass IdambK!
and am and have been abona BderesiLdent- d the State d Fbrida since .1 ds7 d
u~,~.L ~ _ 19
~ and I reside at l'~ ~ Nl 1 /?J
18a..c aad>Vsb~rl
~~T sT. L.~C ~ E _ ST. LUG 1 E ceuat~. Fbriaa. .
and this statement is to be tal<ea as mp deelasation d dtiuaship. actual legal :esidenoe and domie~le in the State d Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES: '
i
" 190 SFP 23 PY I= 45
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+ S1.LUCi CGUNIY.ft A.
•f10Gt~R PQITP.AS
Cift?RN•CIRCUtT CfC'RT
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I FUR1'I~A CERTIFY that I will register at aq local address wbea the regiatratioo boob reopen. and ooh with aD
other requirements d a legal resident d this State.
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~ I FIJRTAER -CERTII~'Y that I have ~ iateation to ratnrn to m~ormer and I -intend to remain in
r-~ J . ~ L. V r ¦ Camt'~
_ (City)
Florida. permaneml; .
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~ Sworn t0 sad aobecribed bsiare IDe this ~.~.G_ daT d
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~ - A.D. i~.~.~
ROGER P01 TRAS. GLERK OF CIRCUIT COtdRT
ST. LUGIE COUNTY, fLOR10A
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BY: ~
EPUTY IERK
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