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~~Cr~.cG:t:~c~ ~~<~:%..i~~i~~: c:~'i:.: ~~t:r:.:~:'r~:',_.:~~'`~,~
•ro 7~~~c sTn~rr nNi~ roun•i~~~ 1~nx nssi:sso~i, ~
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ST. I.UCIC __('UUn'1~Y,1~LURIDA: ~ ~ ~ ~
This is my dcclaration of Uumicilc ancl Citiz~:»tiliir in tltc Statc of rloricl.i that I ain filii~F this day in
accordancc, and in conforn~ity ~vith Scclion 222.17~ l~lorida Statutcs. .
1 was tornicrly a Icgal residcnt of ~~g~4'~. 7l and I
. • (City (State)
residcd dt ~.,~e a~ . Howcvcr, I havc changcd my domicilc to
(Sltcet and Number)
and am and havc bccn a bona Gclc residcnt of thc Statc of Tlorida sincc y day of
~ 19~y and I residc at ~ ~ -3~ ~r-~+~~ ~'p~'-~
.
(Stcect and I~IumUer)
~~un,c p , ST L GIE _ County, I~lorida,
(a~r)
and this statement is to be taken as my declaration of citizenship, actual Ie~al residcnce and domicile in the State
of I'lorida. - •
(lnsert I~ere any perlinent facts, such as sale of property ot business, or relinquishment of employment at tormer
domicile. removal of family to new domicile. purci~au of home, etc.)
• • .
Applying for homestead : . . . . .
~ Entering children in scnool : •
< < -
~ ~~~j
Othe r : ' . -
~ , ~
,
~ . . -
E - . . iO~~~~~"~
C ~ ~~~~p,~ V' . .
o ~~1.~%'~~_ " (1~
LyGi~ , • ~
- - ~ 'm 6Lz'" ' ~ .
~ . ~ . ~'1~'~`~ G~~t
Fllf~ AMO RECOROEO "
SL ~tIC1E COUNIY FLA. ~ ~ . ~ ~
ROCEt~ PO~TRI~S ~
CtERK Cf{CU~T COURt ~ a~(~C ~U'u ~ '
RE~QRp YFRrf1ED.,~,.~ ~
~ Auc 11 -12 k~ PM'73 . . ~
~ 26~06'7 _ .
I rURTIICR CERTIT'Y tf~at I will rc~istcr at my local address whcn the rcgistration books rcopcn, and
comply with all othcr rcquircmcnts of a lcdat residcnt of this State.
I FURT[IL'•.R CEItTII~Y tl~at 1 Ila~~e T~o intention to rcturn to my former domicile, ancl I inteiid to remain in
~ St~. Lucie , County,
~ rlorida, pcrmancntly.
.
~ . - _ -
~ : ~~.r .n
~ ~U .
~ f 1' ~ ••.r , ~ (Name~.
V J ~~LyVij~'• C1'~ ' ' 1 . c
" . T : : ' . . ~ J t
f- /U~,.,,~.~ I ~tO~.` ~1~C-~ ~~~fY'~'~c~
~ • • i . `C• ~i ~ ~ (AdJres.)
~ . . ~ . '
:~~lloil~,~0 an~l'sZ{b:~cr'~Vcc1 l~ctorr mc this yday of
- . .
+ 19--~-~--• .
. .
.
;,Cf~L'R 1'OI'1'I;f~S, CI T:1ZK CTI;C TT COU~:7' .
1;y w D. C BC~K ~1~ PAGE25~~
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