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D~claration af ~omE~~ie ~r~d C~t1z~~~sh~~
'fU THL' STATE AND COUt~~'Y 7'A\ ASSI:SSOIt,
_ st.Lucie _~,pUNTY, ~LORl17A: 2~193~
Ti~is is my dcclaration aC Domicilc and Citixcnship in thc Statc of Fl~rida that ! am filing this day in
accordance, and in conforn~ity with Scction 222. i 7, Flarida Statutrs.
1 was ibrmerly a legal resident of and i
L...'„'~~" ~C~lY~ ~SIAlC~ -r
residcd at - d1' - _ . Hov?cver, I have changed my domicile to
~ (Street and Numbe )
and am and have been a bona fide reside~~t of the State of Florida since ~~t day of
now
~1~ , 19~~, and I /freside at ~S._-t~~° ~1 ~ -
(Street and Numbcr)
~7L „o ~ -1-~~ , S t . Luc ie County, Florida,
(~~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Insert here any pertinent facts, such as sale of property or business, or reli~quithment ot employment at former
domicile, removal of family to ne~v domicile, purchase of home, etc.) ~
Entering children in school:~_ Homestead Exemption:,~
• flLEO ANO R~~p
~T.ItJCiE CDWiTr~
C~E
RCC? Cu1T COURT
RfCORO 1'r~;+~~~p ~
_ ~ l il Zg AM'1~1 ~
2'71938
I FURTHER CERTlFY that [ wilt re~ister at my local address when the rcgistration books rcope», and
comply with all oiher requirements of lega! resident of this State.
I FURTHER CERTIFI' that 1 havc no intcntion to retur~t to my forn~cr domicilc, and I intend to rci~tain in
~ St . Lucie Count
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~ $~d[~f'~'t~ ,~d, •itiisc;ribed betore me tl~i; _ . day of
~t 4:15
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ROG~R ITRAS, C RK CIRCUIT COURT
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(To bc lrecu~cti In ~~upfi~.~fr :n+~1 ori. in ~1 lilr ith t'Irtl~ l'i?i ufl ("nnrl.:md Ju~~h~ atc iv~lb l.~x Aitc~vn)
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