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D~~laratic~n of ~~m~c~~e ~s~c~ Cit~Z~ns~~~~ W~ '
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1'U l'ill: S"1 A"I'G ANU UN7'Y 1'AX i~SSI :SSUIt, . ~
ST. LUCI~: - ('OUNTY, fLOltli)A: ~ ~1698 ~
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Tl~is is my drel:~ration of Uomicilc and Cilizcnship in thc Statc of rlorida that I am f~ling this day~ in f
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a~cor~lai~cr, and in cunformity with S~ction 2?2.17, Florida Statut~s. ~
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I w~is farmcrly a lcgal residrnt af - - and 1
~c~~y)~ ~s~z~~ •
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r~sidccl at Howcvcr, t havc chanbcd my domicilc to
($ttcel aud Nwnher) . ~
and :im and havc bcc~~ a bona fidc rosidcnt of thc Statc c~P Florida sincc _ _ da~~ of •
, 19_2~ , ~~nd ! resi~t~ at ~-~~-~~~r-~
(1 ~ (&irect and Number)
i ~ ~ St. Lucie Count Florida,
~ri'~~ - - Y~
(city)
.:nd this stat~ment is to bc t~~kcn as my declaralion of citizenship, aetual legal residence and domicilc in the St:~te
ut~ f~loricla.
(Inseri I~cre anr pertincnt farts, surh as salr of pruprrty or Lusincss, or relinquishment ot empluymenl at former 1
domicile, remu~~al uf family to nea• dumicilr, purchac~ o( husne, Hc.) j
E1`;T~RI~IG CHILDREII II~: SCl-100L: ti0l•~:STEAD EXEr1P7'IO~~I: ~
If entering children in sc11oo1, ~
please list their names: ;
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_ _ .
_ F1~E0 AlI~ REO~Oit~EO
. st. ~uc~ car~rt~r Fu. ~
~~a ~o~riu?s ~ ` ;
CLFRR GInCWS COURT \ `
- RECbAI~ yE°.~Ftfr ~
~e ~ li i6 AN'75
; ~i~1i~98
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~ I FU1Z771ER CI:RTIFY thal I will re~istcr at my local address when thc rcgistration books r~open, and
~ cc>m~~ly ~vith <<ll vthrr reqtiirrments ~I~ a Icg:il r~s~clcnt ot' this State. ~
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~ l I~~t'I'W~:,jt C'I:RT11~Y that I ha~~c nc~ intcntic?n to rcturn to my formrr domicilc, and I intcnd to rcmain in
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~ -i~lo~ida~,'rcr~i~iil~ = ~ ~c;~Y~
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~ S~~~orn to and sul~~; ;~J bcfor: mc this Jay of e"n e
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~ P.O~CR PvI'('R~iS, CI.CNY. CTlZC11T"i COUIiT
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(Tu • ~a.•e rJ in Juplieale ai~J ~~rif~~:~l (rtc•d ~~i~h ('Ii~rA ('ircuil Cowl. anJ de~ph:alr w,Ui -1. .,a~t)
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