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~ u~rt~t: STATI. n~n cour. r~r ~rnx nss~:ssc~~:,
S t. Luc ie ~~t 26g8
- _ COUN1'1', I~ LORIU~~:
Tliis is my drrlaratiun of Uc~micil~ an~ C'itixrnshi~~ ii~ thc Stat~ of t~lorida iir~i i an~ lilin~; thi~ iiay in
accordancc, and in conlarnrit~~ ~vith Scctiun '_"'.17. ~loricfa Statutcs.
1 was fonncrly a l~ga! residei~t of~9~~._~ ----~C~--~!.- - - and 1
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msidcd at ~_!~~-u'~'~~~~_ . Howevcr, 1 havr changcd n2y domicit~ to
(Strret and Numbrr)
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and am and havc bccn a bona fidc rosidrnt of lhc Statc of rlorida sincc ciay ot'
now a -
- , 19~_, and 1 /~residr at O.__~'? ~~l/ ~%z~ /
. ~ (Strrrt and humber) ~
` St. I..ucie County, Florida,
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and this statemcnt is to be taken as my.dcclaration of citizenship, actual legal residence and domicile in the State i
oi Florida. ' +
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(Insert here any pertinrnt facls, such as sale of property or businass, or relinquishment of employmtot at tormer i
domicile, rrmoval of family to new domicile, pur.hau of hun~r, rtc.) r
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Entering children in school;~ Homestead Exemption: '
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f1~fD ~?a1~ ~~COdBE~ ~
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CLE+~K C3::Ci1lT ~OI~R~ ~
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I FURTHER CERTIFY that I~vilf registcr at my local address ~vhen the registration books reopen, and
comply with all othcr rrquircnicnts of a Icgal resident of this Statc.
I FURTHER CI:IZTIFY that 1 havc no intcntion to rctiirn to my fornicr domicite, ai~d I intcnd to rcmain in '
' St. Lucie
- , - - , Count~~, `
1~ l~rida, Efcrrna nt~}~. (c''Y> ~
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~J•:~~~~'•~'~"'•4~'i~; -r--' - - - ~ - .4. ~ ct, A~o~ ;
•.X ; ~Signature (~aife} +
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S~i-otitbte~ands ~ i~~ilud bcf~fr~• ~~tc thi~ day of S 1,~. °`S`~
~_SY~ •?tl l lri~ re s s
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- - ' ~ - . n. n. ~ _ 74 -
"•-;~~~G~iR''$ ~I,~~t~S, CLERK CIRCUIT COURT ~
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_ BY ~ c G~_~
eP'~r-~' Cl.e~ :
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(Tu 7~r i•t~ rt~lyd +u u(~li~.~lr ~~n! nt+;•ui.~l S3l~ . .ilh 1'!. ~ { 1'u. ~fil ( 1. :ind ~1uj•I~:,~[r t+ilh '1.~. A~tia.wr)
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C'r ~~F.? PA6E 26i?