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TO THk: CLEItK OF T}IE C1RCt11T COURT. - 30f 269
ST, LUC 1 E COUNTY. FGORIDA:
This is my dccln~ation ot Domicile and Citizcnahip in thc Stata oI Florida that I am i'~ling this dsy in aceordence. and in
tonformity with Section 2`r2.17. Flori Statutea. - ' ~
I was tormcriy a legal residcnt of and I
, (Gtr) lStats)
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resided at • . However. I have changed my domjcile to
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and am and havc bcon a bona tidc rosidcnt o[ lhe Statc ot Florida since day ot
19~. and I reside st ~ ~ a ? . ~ . ~ 3~ fl.,,j'~ rI / ~ .
(Street and Num~er)
' ~ ST. LUC I E County, Floride,
(Cet~)
and lhis statement ss to be taicen es my declnration oi citizenship, aetual legal nsidence and domicile in the Stute of Florida,
IF FOR~TNE PURPOSE OF ENROLLtNG IF FOR HOI~tESTEAD PURPOSES~
CHILOREN IN SCHOOL~ PLEASE STATE _PLEASE CNECK: ~
HEIR NAMES:
\ 3~~9 .
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• fi~eo a+~~ 4tcoaoEo
. ST.tUCiE ~OUN1Y F~A.
. ROCf " F ~~TRAS
• - CLERK Ct~;~~!* COURT
RfCA-~ ycF:r~ED
A~R 11 i 17 PM '75
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1 FUHT}IER CF:RTIF~' that 1 will rc~i~tcr 1t rny lc~ca) address M•hen the re~;ist_r. tian t,ooks reupen, ar~d eu:npl~ wiLh :.i!
; ot},cr *equirc~nents ot a Ic~;a: rr.idcnt ut t1~iti Stat~ .
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i I UI TIII;:t ~CF,I ~ Y th~: ( I~a;~t nn inti-ntio?i to return to m}• f~~rmc•r do:~~ieile, , nd 1 intcnd_to r~•maiti i:~
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