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ST. IIK~ CpINITY- FLA.
Declaration of Domicile and' Citisenship
TO THE STATE AND COUNTY TAY ABSB',t380R,_
Sai t I.rmt a COUNTY, FLORIDA:
This L mq decLration o! Domidle snd GYtisenship in the State o! Florida that I am !llin~ thin daq in
accosdanoe, and in coniormitq with Chapter 222, Section 222.17, Florida Statutes.
I wsa lo~rmer~y a le~sl resident o! ~lSlli4~ tam) ..~____..~_____, 8es_,~8e ~~ .._._____
and I resided at----S88-CurrY__w!~~~_....__~.-----•--------------_._. However, I have changed mq domicile
(f3tewt aad Nvmb~s) LEIIfl
~ ~ ~_.__ t._.... t..~.a ~~ t.~.,ns •ti ~+ts4n nt ~nr~tl~s ~f!!M - --- AeY O!
w ~U iili iiiY iiiYO i/Gi'.~l ~ iJi7~ii ii4i~. i1:tNNr+YY ~i' i.L°c I.rww va s _ - -.
___..44tQber _ . 19~~Q and I reside at ~ 3 BoY_ S50 , ~_,-_~ _____.._ _.
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^F~~ pi~.~+ _ ~ _, ------- --- Statt:~------~----_____----County, plondA.
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and this statement is to be taken aa. my declaration o! citiunahip, actual legal residence and domicile in
the State o! Florida.
i s~a~r ~ a ~~ to ~ do®idM. vaxWw a ~i1e~nisbm~at a~ ~mylo~t at
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I FURTHER CERTIFY that I will register st my local address when the re~lstntion hooka reopen.
and comply with aU other requirements o! a legal rrslde®t of this Sots.
I FiJRTBER CERTIFY that I have no intention to return to ~ !o~ domicile, and I intend to remain
~„?ort Pierce _ _ St.Laai•
__._County, Florida,
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