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~iu ~c~ti~ s~t~n~rt: ~,Ni~ c~uuh~r~~ ~rn~ :1~si:ssc,ii. 2`734'72
S~.Lucie ~
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'Il~i~ is iny drelaraticsn c+l I)onticil~~ arnl ('itircnshi~, in th~ St:itc of I~lorida that I am filink this ~I.iy in €
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arror~ancr, antl in cc~i~lc~nnitl' w~itlt Sr~ti~~i~ ~~?.17, t~lori~la St.?ttrtr~. ~
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1 was f'c~nncrly a lrgal m:i~irnt ol~ - - ~ /?2 , ~ / :~nd 1
(City 1 (Slate)
r~ si~lyd at _N_ -_~t~ _ 0'4.~-~-~ How-e~-rr, 1 havc changc~l my domicilc to
(Strert and Numbrr)
and am and havc bcrn a bona fidc residcnt of thc Statc c~f Florida since day of.
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T10W ?
_ O ~ 2 , 19_ aiid I /~csidc at --QJ_v~o? ~ i
(Slrcrtand Numher)
1--- iE,~~' F------~Gi¢ Sti. Lucie - County, F=lorida,
(c~i,•)
.~n~i this statement is to be taken as my derlaration of cili-r.rnship, actual Iegal residence an~l domicite iri the State
of Florida. ~
(Insert here any perlincnt facls, such as aale of pr~~petty ~~r business, or rclinquishmrnt of emploYmenl at fonner
domicile~ remoral of (am~ly to ne~v doniicile, purcl~ase o( home, etc.)
, Enterin children in s~hvo-1:~ . ~ ~
g Homestead Exemption.
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~ 1 rURTHI:R CI:FZTIf~l that I~vill rc~~ictrr at m~~ local address whcn the rcgistration books rcopcn, and
~ com~~ly with all othcr rc~~uirrmcnls of a Ir_~al rctiidcnt of thi~ Statc.
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~ 1 FUKTt1EK CLIt"TIi=Y that 1 ha~e n~~ intrntion to rcturn to my former domicile, and I intend to remain in
~
~ St. Lucie
~ ~~L~ ' ~-P- - -~f_ i~~s`~E"- . ~~ountY,
~ F~lorida, prrntancntly.
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~ S ignature iusUanci )
- . ~ .r~; _ . ? . ~~~G~ ~ _ -
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- - ~ ~ ; , Signature (wife
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" Sy~rorn to and ~ubpCf4l~cl bcfc?~r mr thi~: ~l:i}• of ~(//Y'e/ S ,E ~L !/V -
- . v ~ -.ailing a7cIress
- ~ 4 _ . n.i~. t~~ 74 ..~f- ~,E,e~ ~L~d
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- 1tOGi~~ ~'P~Y~r~ir,s, LT:R1C CTRCUIT COURT
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~3y e~pi'it-}1~1 -
_ (lu Lr .•~rcutrJ tn J~~~~lic.~lr .~n.l nnp•n drd wth (l~ ~l f i~~uil ('~~nft.:mJ d~y,h:.~lc v~lh Int ilc.cc~rn)
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