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D~ctarafion o~ Do~icite and Ci~iz~nship ~~
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5~.22~3
TO THE CLERK OF THE CIRCUTJ' COURT.
ST. LUC f E ~pU~y, ~,pRIDA;
This Ls mr deelatation oi Domic~e and Citizeaship in the State of Florida that I am filing this da~ in aacordanee. and ia
conlormit~ a~ith Sectioa 2?'1.17. Florida Statutes.
I vras forinerl~ a legal resident of ~µS e^'~ ~~-!% ~"~_ . ~~~ iDd i
l~t~) ,. (StaW
resided at ~a o{Q~~_ ~,~ f~ • 4t.~' ~i~ - HoR ever. I bave cbsnged m~ domic.0e to
(Strsst aa~Nomber)
and am and have been a bona 5de resident of the State oi Florida since ~- ~~` da~ of
_ V~ ,19~ v- and I reside at ~~' ~~ ~~
-~ ~tStreei aad Number)
~=-~. ~~tr~~ f'-~. ~ ST. LUG 1 E Count7.Florids.
IC~
and this statement is to be taken ~s my declaration of citizenship. actuallegal residence and domicile in the State oi Florida.
" IF FOR THE PURPOSE OP ENROLIING
CHILDREN IN SCHOOL~ PLEASE STATE
THEIR NANES:
IP FOR HOMESTEAD~PURPQSES~ -
PLEASE CNECK: ~
~
1981 JAN -2 i'~ ~ 4 7
FIi.CC RI~[' «CU+~CIf D
S ROGER ~OITRASa
CtERh CIRCI•'li~~
iF'::F:';f"',.:t"- ---
51.2243
I FURTHER CERTII~'Y that I ~ t71 register at m~ Iocal address ~vhen the registration books reopen. and oompl~ witb aD
oiher requirements of a legal resident of this Statt.
I FURTI~R CERTff'Y that I have no int,~ntion to return to m~ former domic~e. and I intend to remain in
~p,Y ~ -,- 5 T, L U C 1 E , Count~.
((St~) .
Florida. permanenti~.
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Sworn to and subsrn'bed before me this da~ ad ~~~
~ ~.. / 98/
ROGER 1 TRAS, ERK OF C IRCUI T COCd'rZT
ST. LUC i E GOUNTY, f LOR 1 OA •
• +_
- BY: ~ "
~ 1~cPUTY ~~ERK
a~x3~~ P~~E27ss
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