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~~claratio~ ofi f~omicite a~d Cifiz~r~s~~ip
.
TO THE CLERK OF THE CIRCUIT COURT.
ST. LuG 1 E covrrrx, ~oRln~:
S~ ~5~3
~-
This is m~ declaration oi Domic~e and Citizeaship in tbe Stata oi Florida that I am filing this ds~ in accordance, and ia
conformit~ a~t6 Sectioa 22Z.17. Florida Statutes. ~
I R as lormerlv a legal resident oi ~~ S T ~~~ ~~~ ~D~ W i~ '~ s s' and I
~ ICrt71 ~ lState)
resided at ~ I W N ~~r ~~~ , However. I Dave ebanged m~ dotnic7e to
(Stie~t ~ad Number)
and am and have been s bona fide resident oi tbe State of Florida since ~~ day at
~,, ~~~ ~'~NN r St E ~2 ~ ~~ ~~vE'ty'cFSI
• -19 and I reside at ~ 4B.~iDJ
iStreet aad Numbe~)
~'~ t~i S' EN ~F~4~ ~ 3 3 4 S~_ ST. I.UC I E co~t~, Florida.
t(~I
and this statement is to be taken as my declaration of citizenship. artunl 1ega1 residence and domicile in tbe State of Florids.
" IF fOR THE PURPOSE OP ENRpLLiNG
CHI LOREN 1 N SCHOOL~ PI.EASE STATE
TNEIR NAMES2
f
IP FOR HONESTEAD PURPOSES~
PLEASE CHECKt ~ ~
i
1981 JAN -7 AE4 II~ I3
F~~.ca ~nr ~_. coFut o
st~uci~ cou:rT r. ri a.
R06ER POtTRAS
CLfRK CiRi.1:IT COUt~i ~
PfCGRf) :'fF.7fiF^
5~ ~543
I FURTHER CERT'IFY t6at I w~l register at my local address when the registration books reopen. and aomply witb all
other requir~emeats of a Iegal resident of this State.
I FUBTHEH CERTIF'Y that I have ao intention to return to my former domic~e. and I intend to remain in
--.-, - 5 T* L U C 1 E , Count~.
_ ~~b!1',SF~ ~ f1~C~((xt~l .
Florida. permanenti;.
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Sworn Lo and subscr~bed beiore me this ~ dap od
~ ~~-~ _ ~.D._ / 98/
ROGER P01 TRAS, CLERK OF C 1 RCU1 T COCd~2T
ST. LUG i E GOUNTY, f LOR 1 OA •
. .. _
BY:
ti r~ uEPUTY I.LERK
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