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Declaration of Domicile and Citizenship
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TO T'~ CLERK OFTAE CIItCU1T COIJ1tT. -
ST. lUC I E ppv~y. ~,O~A;
ZLis is m~ declaration d Domicile and Cltissaahip in the State d Florida that I arm 84nS this dq in acoordanos. and in
ooaiortrnit~ with Section 222.17. >!7ocida 8ta4tNt.
1 was forme a bgal resident d ~ ,1. ~ and I
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resided at ~ - /
kb~. ct,lh However. I leave chanced m, domin'1e to
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and am aced Dave been a bona Sde resident of the State d T'7otrida since D dad d
66~~ QQ QQ
198Q_. and 1 reside at .~.~L~1.~~~r~'6~~~~.
(ee+rw asa Na~bte)
ST. LUG! E
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and this statement b to be tal~en as nq deeLration d elti:ensDip. aetnal legal residence and domicile in the State d Flotrida.
1F FOR THE PURPOSE OF ENROLLING !F fOR HOMESTEAD PtlRPOSES,
CHIt.OREN IN SCHOOL, PLEASE STATE PLEASE CHECKS ~ '
THEIR NAMESS
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~c0 SAP 26 t'~ 12~ 08
- F~LEO RNt ~:CpiiUtD
- ST.t.UCIF COL'N~Y.FLA.
ROGER POtTRAS
CLERK CIRCUIT CCURTj~
~ pFCOROI•ERIFSE~_
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I FtTRT~ CERTIFY that I wID regaRer at m7 foal address wDen the registration booiu reopen. aced compy with sD
otDer regniraments d a legal resident d this State.
R
I F'[JR1'HER 'CER1')~'Y tDat I Dave no intention to return tom former domie9e. aced I intend to resoain is
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Florida, permaneasl; .
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Gu.~ }
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6wora to aced sobevibed before me this ~ daT of
A.D.14~y~Y 3A Rh A R A Mc Ge o u~itl ~ i
ROGER POITRAS. CLERK OF CIRCUIT COt~tT L~ANie
ST. LUGIE COUNTY, fLOR1OA -
EPUTY LERK '
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OR
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