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Declaration of Domicile and Citisenshi~, I.UCiE COUkTY, FLA.
TO Tii>~ STATN AND COUNTY TAR ASi~S8Ox.
sr. i.~cz: c~ovrrrY, FroxlDe:
This ~ ~ declaration of Domidle end (Yt3iAnahip in the State of Florida that I am lUing this day in
accordance, and in conformity with Chatter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident oi_______.CSICwtiO _-- ILLINOIS ---____-
(Ci~)
and I resided at.~~~~_1M12i`frA._~l~~l~t---------_._---------------------------. However. I hove chaa~ed mY domldk
Sbrd - ---------..day of
to and am end have been a bone llde resident a2 the State of P7orida since--_-_-- -. ------- ---------
Deoesbsr _ 18.~V , and I reside at---~.+~~~~-.s~a~+-_.~~w___---------------------------
___~-------- - ----' (Street sad Number)
port Pieroe
.lrOrt Pieroe____~~~-----_County, Florida,
ice!
and this statement is to be taken as my declaration of dtisenship, actual legal residence and domicile iu
the 3tate~oi F7orich.
((Lneert ba+ w partirwnt fe~ota. sneb M ealo e~ yert os boeiaeee. or rdisvnmhmeat e~ emD~7~t ~
forser do~idle. semso~~l of iasiis to new do~ois~. passe ed >~ moo.)
Enterin6 two children is pnblio •ohoo~.
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St. LUCIE COUNT(. f LUn•~+~
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I FUItTHEB CERTIFY that I will register at m7 local addreea when the regLtration hooka reopen,
and COmplj- wi..h :... ~...~i avy::..v...a.... d ....s~..~...-~--
I F'UIt'>~ER CE$TIFY *hat I have ~ ~tes+~ ~ u+etura to mr former doaaicile, and I intend to remain
~ lort -Pi ero e _ et . Tw~w i • ____- _Coonty Florida
ptb-• (ab)
Stanley Holseatxa~..~
<: ~ cA~ree.~ .~
Sworn to ygbe~~ybued-~oer`~e shia...~.dyr of
aE .....,,-~ j .; .,.
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