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"t'O 'I'i 11: S'l~~i'1't: ~~I~ l) ('Ul ~N7'Y 'I ASSI ~SSUIZ.
St.Lucje
. -----.----._CUl.~N7~Y, I~I,Ultli)A: ~
'fl~is is my drel:u~ation ul U~~micil.~ ,?ncl C'itiz~ii.hi~~ in th~• St:itr of l~Ic~ri~la thal 1:un fili~i~ tl~is ~I~~y ii~
:ICCO~l~:111C1'~ :i11U 111 l'(~I1~UI.p11~)' \\'1[II JClllv 1,:~.~., i i~ i i~)li~i:i `~ii:ii~:i~.'~. _
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I was formcrly a Irral resid~i t of '---'~_~t~ Ccp_,-- ~
, - ' and 1
~ (Cil)). " ~(State) .
residcd .~t a?, 2-C'~~Q,t ~l!'P,~~~_~---- - Howcvcr, 1 1~.+~~c chan~;cd my aomicilc to
~ ~ (Strett auJ ivumhrt)
and ~m ~rl~d l~avc bccn a bona fidc resictciit ol~ tlie State of Florida since ~z'~.._ day ut'
~ now ,
w 1 ~ ~~~~a i /F~S~a~ :?t ~~G~- t
(Street and Number)
.',u'i c~~~ c~- tir~t ~Qq~ St . Lucie County, Florida,
~ ' (c~~y) ~
and this statement is to be taken as my deciaration of citizenship, actua! lcgal residence and domicile in the State
~f Florida.
(lnse?i leere any perlinent facts, such as sale of prup~rly or business, ot reliuquishmrnt ot empluyment at tormer '
domicile. rrmova) of family to ne~• dowicile, purc6ase of home, rtc.)
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g 7 ~ ~ ~C ~ ~C ~h...~ _ sc., t -E'~~-, ~ ~f
Enterin children in school; L~ J c~ '
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263035
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; I FURTf(ER CERTIFY that I u~ill rcgister at my loral address when thc registration books reopen, and
' comply with all othcr requiremcnts of a lcgal resident of this State.
t •
~
~ I FURTNCR CE 1FY that 1 have no intention to rrturn to my formcr domicite, and 1 intea~d to rcmain ;n
r ~ _
; ~ ~ ~.z~_, St . Lucie
! - ' - - - , Cou nt Y,
t Florida, perm~ne~tty~ _ cc~~'~~ ~
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`f v -i . ~ - (Name) _-.r E 3
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`y~y j t•~: v - (Address) -
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~ $K'+~CtC?~'O~t~o'~scrihed beforc mr thi, c~ay c~f
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~ ' • ..,ft<< , A.f). 19
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ROGI:R POITIi/;S, CLEItK CIRCUIT COURT - ~
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