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Dectaratio~ of Don+lail~ and Cltiz~nship .
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TO THE STATE AN~ COUNTY TI1X ~~SSE3SOR. ~ '
ST. LUCIE COUNTY. RORIDA: ~s~~'76ay ~
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This is my d~dawtion of Da+skil~ a~d qti~+shtp tn tt» St~t~ of florWa t~t 1 a~n filinp thb d~y in aooor~d~no~ and
in aonfo?mity with Chap~ 2Z2.. S~cfbn 2Z'1.17, Horida StatuNs.
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1 was forn~ly a Ip~l nsii~+t of
Ki~Y) . (Stat~)
y and 1 ~td~d ~t / ~ ~ ~ ~b ~ ~ct ~Y ~ . - How~wr 1 hiw cha~q~d nhr domki~
(StrNt and Nunnb~~) _ ~
b a~d am ~nd h~ve be~n a bona fids ~id~nt of the Stat~ af Hoiida sina , ~Y ~
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3 .na ~ ~td. a? lD ~ ° `S • L- ~ .
(Strwt wK! Numb~
l~ORT M~CR fAM1T LUC~ COUNTY. lLOR~A .
~nd this stateR»nt is to b~ taken ss my dedaratio~ of dti~nship, aetual lepal r~sid~no~ and domidl~ in tM Staf~ of Horkla.
. p~sert Mro any pertin~m fads. wd~ as sal~ of pnoperty ~ busin~ss, or nHnqui~r»nt of ~r~ployn~nt
~t'formK danidl~, ronwvai of family to new domkik. Purchas~ of hom~, Mc.) •-»-..1
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t964 ~ _ , B~pK .
. ROGE ~ ~ ~ 39
ST. [UCIE COUNTr S' ~RK . .
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i Fua~t c~rrnFlr ~t,~t i wiu oo~+~r `~'i'
ail ather roquiromsnts of a le~al rosident of this Stats.
1 FURTHER CERTIFY that I h~ve no inteMion to. rotum to rny form~r domkile, and 1 inhnd to rom~in in FORT
E
PIERCE. SAINT LIJCIE COUNTY, FtORi~A, psrmsnsntiy.
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~••••.....•~b4nci'~wb~aibed b.w~. m. thf. dav ~Q~
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~T . . Notary P+~blk
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