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; c~ 'l~lll: STAT~ nNt~ cUUNTl~ •?~;~x ,~ssi~ssort, 266389
St.Lucie
---COUN~'Y, 1~LOIt1UA:
Tliis is my dcclar:itiun of Uomicilc ai~d Cili-r.cn,hi~~ in tl~c Statc c?f i=lorid:~ thai 1.?m lilin~; this ~lay iii ~
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,:ccora:ince, and in conforntity with Scetion ~~2.17, r•i~r~~ia Statutcs.
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1~vas formrrly a Ic~;:?I residcnt of ~ Y_ _ ~
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, (citY) ~e)
r~ ~iclyd at ~ . Ho~vcvcr, 1 h3~~c changcd my doi»icile to
(St~eet artd NumDe?) ~
aiid am and have bcen a bona ftdc resident of tl~e St.ite of I~lorida since day of
- now - .
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~ , and 1 /~csid~ at ~a ~
(Stt~ nd Num t)
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~ ~ >c c e J~~ /~.EZ,/~4 ~~Ci?'-~~ -c-cc~' ~ S t • I.UC 1 @
County, I~lorida,
(c~~y) '
at~d tliis statement is to be taken as my declaration of citizenship, actual lebal residence and domicile in tl~e State
of rlorida. -
(Inutt hete any pertinnot ta~ts, such as salr of propctfy or busincss, or rctinquishment•of employment at former
domicile, removal of family to ne?v domicile, purchase of home, etc.)
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F~~E~,?K~ kecoR E ;
sr. ~~c~E eouNrr ,
_ ROCEQ P~1TRA$
~ C~ERK C~r:~~iT COUR
RFC~Rn vE~~x~ED~~,~,~~
~ Oct I8 10 s3 AN'73
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I FURTHER CERTIFY that I will rcgister at my local address when the registration books reopcn, and
comply with all other rcquirements of
a legal resident of this State.
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.1 FURTHER CERTIrY that I l~ave no intention to return to my former domicile, and I i»tend to rcmain in
E ,'fY'syL~~~ ~l~" ~Cc t~C, .S~' . Lucie ~ COUIlt}l,
T'torida, pcrmanently. ~ ~~''Y~ ~ ~ ~ . _ - `
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' ' L. • (Name) G~Ma..° /~.A~! '
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~'-f.c-C s~ ?ct-.ti~" - C c
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Sworn to and sut~~i~d.bcforc mc this ~day of ~
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~ ~ , A.D. ! 9-_73 . ,
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ROG~t;~OI~~S`',: ~LERK CIRCUIT COURT .
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• ~ ~ BOOK ~~9 ~'ACf ~,Ve1Q -
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- ~r ~;'rr-; ~ ~.,~~~~Deputy C]_er~- , ~
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(To bt execulyd in dupticale anJ uri~t~n.d filyd ~+~U~ t'Ir~l. fircuit Ct~urt. anJ deplicalr ~cetb Tai Atx tisor) :
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