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rc> ~r~~~: sTn'fl: AND COUNTY -rnx nss~~ssott, 2'7Q653 ~
St.~.ucie
CUUNTY,I=LOR11)A:
Tliis is my drelaration ~f Donticilc and Citi~cnship in thc Statc of t~lorida iliat I am filing this day in
accordancc, and in conformity wiNi Scrtion 222.17, Floricta Statutcs. ~ . . -
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I was formcrly a Irgal residrnt of ~~~7~'i .,~n,. , ~ ' and I
(c~~r) (
residcd at ~°v d S~ . Howevcr, I itavc changed my domicitc to
~ (Street and Number)
and am and have becn a bona tid~ r~sident of the State of Florida since day of
now -y,
~ e~ • , 19~ and I/resici~ at -~~Z ' 1d ' ~ 3 S t-
(Stteet and Numbet)
, St. Lucie County, Florida, ~
(C;tr) E ~
a»d this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in thc State ~
of Florida. . ~
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(Insert here any pertinent facts, such u sale of prope~ty or business, or relinquishment of employment at fo~mer ~
domicae. remoral ot (amily to new domicile. purchase ot Aomc, etc.)
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Entering childr-en in school: Homestead Exemption: ~ ~
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. r uo ~~?o R RpED ;
- - t~. ~ucie co~r~r ru~. ~
- AOCFR ~O~tR~S l
- CLERK C.i:CU1T COUAT
AECCRO VER~f1E0
. - O~c ~ T 12 ~2g PH '13
- . " 2'70fi~3 ~ `
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I FURTHER CERTIFY that I~vill register at my local address when the registration books reopen, and ~f ~
compty with a11 otl~er requirements of a legal resident of' this State. ~
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I FUjt"THER CERTIFY that I havc no intention to return to my former domicilc, and I intend to remain in
Sr. Lucie ° Y
i , County, ~
Flo~a; ~iet~l4~ne~tiy. (c~`''~ 1- ~ f
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E • ~~C. ~.E,~,4;•'~~~` - - (Addreas) • ~
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; Sworn to'and subscribcd bcfor.. me this ~ day ot
~ ~ ~ - , A.D. 19 73 , ;
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ROGE R• POITR~~S , CLE RK C I RCU IT COURT '
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~ ~ -'~y - -r: ° ~R 2'~. p~~E~~83 ~
P Y ~t,GK
(To bc e~ecvlcd in t1~~Ill'JI~' JIIiI urig~u.~ d~•d ~v~ll~ l'Irr{. ('ucuit l'nurl. ~nJ Ju~•h:alr wilh 'I:~r A~sestor)
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