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Decfaration of Domici~e and Citiz~~t~~iip ~
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234624 ~
IO "I~IU• ti7~,~~1'1: ~ti\1~ (~Ol!~'I l' "I~.~\ ASSI StiO{t.
St. Lucie
_ _ . ('UU\~1'Y.I~I.Ultli):1: ~
'I~hi. i. m~~ ~icrlar:itic,n uC Ikm~irili~ :uui ('~tir~n>hi~~ in th~• St:it: ~~t~ (~I~ri~la lhat 1 am lilin;, titis day in
acronlanrc, ancl in co~lfc~rmity ~vitli Scction ,~".17, f~lorida Statut~s.
t was fonnrrly a I~,~al resi~l~ nt of _ Cincinnatti ohio and 1
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. 1677 th State . Nowcv~r, 1 havc chari~c.d my domicilc to
rra~~lyd at . - - - _ - - b ,
(Slrrrt anJ iVumMr) ~ lsth '
and am and havc br~n hona tidr r~sidrnt af thc Statc ul~ I~lorida since day of '
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April 72" ~ncl I rc.idr :~t _ 121 West Glen -i- ~
- , (Slrrrt and Number) -
___J_Ft _ Pierce _ _ St. Lucie _ _ County, Florida, ~
(c~~y)
and this statcmrnt is ta he takrn as my declaratian af ritizenship, aciual legal residenee and domicile in the State
of rlorida.
(Insrri herr a~y prrlin.nt facts, sud~ as sale of proprrh~ or husinrcc, or telinquichment ot employm~nt at formet t
domicJe, remo~al of family tu ne~v dumicilr, purchasr of home, rtcJ `
Entering children in school
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Estabkishing residence
234624
• fILED As~D FIECOROEp
ST.~UCIE COUNTY fLA.
ROCcR F~1?RAS ,
CIERK C~RCUIT COURT
RECORO VE~?~F~ED....r-~ ~
Atic 3 2 39 PN'11~~;d
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I FURTHER CERTIfY that 1~~-ill rc~ister at my loral address w~hen the rr~istration books rropen, and
comply with al) otlier requirements of a Ic,~al r~sident of this State.
I f
URTHER CERTIFY that I ha~•e no intrnti~~n to return to my tormer domicile, and 1 intend to remain in
Ft. Pier ce St. Lucie
- - - County,
Flor~cla, prrmaiiently. tc~~,~>
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~ • - ~ •.I~ . (Kamr) i
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o T~~~: = N edra Collett ( M rs Edwa rd ) ~
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~~t~ri~. ~,c~uti~•s~~l~srrihe~l bcf~r. mr thi. d:iy of
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- - - - - - . A.I). 19 ~ - • .
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Nolaty Publir Slrtr of I I~HIiJJ JI 1 er:r ;
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I~fy Comrnission rxrire. /S 7~
(To br r~tcutcd in du~~lkalr and nn~ m.~l f~l.-J ~.ilh 1lc~k l'~rruil Cuurl. rnd Jupliralr ~vilh Tax AswcswK) ~
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