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orataraNo~+ 01 Oon~lau~ s~d C1tis~nshlp
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To r~ sr~~ M,o couNnr r~x ~u~ssoa. .
s~. wciE couNnr, aoRio~?:
This ii my d~d~~atio~ oi Domicil~ a~d Citi~nship in th~ St~t~ of Fl~ida that I~n+ filirp 1hb day ie ~ooo~dai~a a~d
in conformily with Chapt~r Z~l. S~ttion ~Z4.17. Norid~ StaluNa.
i was formKly • Ipal ~id~r+t of ~ CLS~~1~lt ~n~.~ ~r'~•,n~.
Kih) (Sta~
~nd 1 rostd~d ~t ~ _ ~ • . I~ow~vK 1 haw dwn~c! my domWle
(SthM and Numb~~) _
ro and am end haw be~n a bona fid~ rosid~nt of th~ Stat~ of Norida sinw day of
. t9~.. •nd ~ ~atd. er ~ - 18
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PO~T N~CE. SAMIT IUC~ COUNfY, lIORIDA
~a~d this statement is to bs taku? as my dscleration of citi~nship, actua! IpiL nstd~no~ and domkil~ in fh~ Stat~ of~io~ida.
(inssrt hKe any p~rtinsnt fatts, wch a: sale of propKt~t or busin~ss, ot r~linqui~Wr»nt oi ~nploym~nt
at tormer domicii~, rorrwval of family to nsw domkil~, of ho~rN, Mc.I_
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~v?t ~~~tc~ ~o..~ - ~ p ~o RjL~~~iAI ~ ~~00 I
~S 0 REC~~D
ST. LUCIE COUNTY. FI:A.
RECOR~j ~~j~~
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~~0 ~ulV ~ 7 ~ Z :
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-ROGER ?OITRAS` -
. _ CLERK CIRCUIT COURT%
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~ 1 RJRTF~ER CHtTIFY that 1 will comply with dI othK nquir~h vf a Ip~ ~id~nt af thb S~it~.
i FURTHER CERTIFY that i hsve no inteMion to return t~ n~r tormK domi4le, and I int~nd to nm~in in FORT
~ PIEttCE, ~AItMT LUCIE COUNTY, FLORIDA, permanentty.
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~iA~6tM`~o jrid wbxnbsd befort m~ this day of 1~.
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CLiRK C.KCW ONRT . N~ary_Pub1k ~
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R~ w~e~Ni M~NcN~ a~ ~i~M~l Al~i wiil~ t'~Ic CbwiM CwN, a~i ~ii~ ~ri~M Tas AM~J
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