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Decl~r~tian ofi Domic~d~ and CE~i~enship
To -r~n: sTn~~~. n~.u c'OUN'('Y "fnx nss~:sso~i, 265986
S~ .I,uc ie
~__~CUUNTY, f~LURII)A:
Tl~is is my dcrl:~ration of Uornic:ilc~ ai~d Citizcntihip i» thc Statr of f~lorida that l au~ liling Ihis duy in
accor~a~~cc, and in ca~formity with Srction'?2.17, I=lorida Statutcs. ~
I was formerly a l~tal residcnt of '/.~1~ and I
~ (city) (5tate)
resided at , ~ / /~J
reX /1~- ~ . Nowever, I have changed my domicile to
(Strett anJ Nvmber)
and am and have bren a bona fidc resident of the Statc of Florida since day o1~
now ~p ~j
~ , 19~_, ai~d 1 /~residr at ~ ~
(Street and um r)
~e9c~~e,- S t . Lue ie
. County, Florida,
(c~ey)
ahd this statement is to be taken as my declaration of citizenship, actual legal residence and domicite in the State
of Florida. -
(Insert here any pertinent tacts, such as salr of property or businrss, or relinquisl~ment of employme~t s! former
domicile, removal of famity to ncw domicilr, purchax of home, etc.) _
Entering children in school: '
~ .
, ~ '
.
} fILEO AHD RECOR~EO
c ) ST. ROCE PBU~RAS ~A~ ~
~i R~CORG YEk! IED COURT
~ Oci l5 IO lo AN'73
265986 .
I FURTHER CERTIFY that [ wil( rcgister at my iocal address when the reg,istration books reopert, and
comply with all other requirements of a tegal resident of this Siate.
I FURT[~ CERTIFY that 1 have no intention to return to my fornier domicile, and 1 intend to remain in
~ T ~ Q S*. . Lucie County,
Florida; permanently. ~~''y~ ~ . '
: ' . ~ ~
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~ ~i~,Y .r ~ (Na~Ile)
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• ~ • + .J'•~!~ c'. ~1 ~ ~ - ' (Addreu)
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~ S~oFr~ ~t~-~dKd'~~',}~.~?Ucd bcfore mc thi~ _1~_ day of
• . .
:,`~;~~Ca~~- , A.D. 19 _ 73 . .
~ ROGER POITRAS, CLERK CIRCUIT COURT .
E - . _
~ ~L ~ - rn c ~0~~219 FAGC20~3
` Deputy CIe
;
(Tu bc cacruted in Jupl~r~tr anJ ut~~ ~n.il (il~ rth t'Icrl, t'i~ruit Courl. :~nJ Juplic:~lr ~~ith 7ax A~xssur) .
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