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D~c~uru~ifln o~ ~~rnE~E;~ ~s ?cf Gt~i~~; ~J~ti~a ~ .
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u~ri ~e: s•rn•r~ nn~~ counl~~• •rnx nssr:ssok,
St.Lucie CUUnTI', t~LUK1UA: .
Tttis is my dcrfaration oi Damirile :+nd Citiienship in Ihc Stat~ af Florida thal 1 am filing this day~in
:f~cofc~3t1CG, atu! i~~ canforn~ity with Scrtion 2''2.17, Florida Slatutcs. • '
1 was tormcriy a Icgal residcnt of ~ ,~0 and I ~
/ '~r) (state)
resided at 1 ~ C~ yr~~NC oOG~ . However, I have changed my domicile to ~
- ~s~~«t ~~a rr~ma«~
and am and have been a bona fide resid~nt of thc State of H'lorida since C' day of
now /
_ , 19~ and I /~e.~sidc at ~ /Ud ~uS >
( tceet snd Number) ~ ~
: ~ p n ~ ~ ~ ~ ~ ~ l t . S~ . Luc ie County, Florida, . ~
~G~r~ ; r
aa~d this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. `
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(Inxrt here sny ~?ertinent tacts, sucA as sale of ~ro~+erty oc busincu, o? ~elinquishment of ea~ploymrnt at fo~me~ #
domiele, cemoral of tamily to aew~ doneicile, purchase of Aome, ete.) -
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Entering children in school:~ Nomestead Exemption: ~
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2'~02Q8 . . ~
Fi~EO ~?yo RfcosuEO ~ ~
sT. wciE couNn ~u.
~ocfa ~otrn~?s .
C~ERK CiRCiliT COURT f
REC~4D VEG?FIEO.~....~~ ~f `
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I~`C ~0 2 06 P~'~ ' .
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and ~
comply with all otl~er requirements of 3 lebal resident of this State.
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I U EIZ CERTIFY that I have no intcntion to rcturn to my former domicilc, and I intend to remain in
~%1~ / Sr . Lucie ' '
.~~~-.~i '
. , , County, $
~ rlorida, permanently. . ~
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~ , ~ 0 J''•,; • ~ ~ ~ , ~ J ;
~ ' ~ `'i ' • = ~ (Name) , :
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' • : ~ ; _ ~ • (Address) • ~
~5w~,tv. ~~iiscnbcd b~:for me this day of ~
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_ • •.~.~k~,-,~~,~t.~-.~/ A.D, l9 73 J'
ROG~P. POITRAS, CLERK CIRCUIT COURT "
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f -~nepu t_}r~7. c rk ~ s;
(To Ix~ eueuted in Juplwa~r a~wl ~~rig~n~l td: d Mdl~ t'1.•rl. Circuil (-uurt. anJ duplicrft with T.~c Acscssor)
z~~:~ Z~1 F:`,E ~U~~ .