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Declaration of ~om~c~~e and ~~~iz~~~f~~~
3~5485~
TO THE CI.~ItK OF TIiB CIRCUIT COURT.
ST. lUC i E ~pUIVTY~ FLORIDA: ~
7'bIa fs aa~?_ deelar+~tton o[ Domleile ~nd Clti:eashlp ia the State ot F1oeWa that I sm filiag tAis da~? ia aoeo~danoe. and ju
ooaforanity witb Seetioa 222.17. Fbrida Statutes. -
: r ~ e Gv e u,d I .
I w~s t tmerl ~ legal resident of 1'~i ~~~P /
IC~V) l~at.)
a~ e o A~~c % S~ " Ho~vever, I have char~ged np? domicile to
lBtrMt a~ NombK1 .
•nd am and bave been a hona fide reaident o[ the State oi florlda siaee ~3' ~
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,_.191.~~L~ snd I reside at • S/ ~ ~ ti°
~ 8 ~u P ~ ~ ~G-- -
~ lBtrMt ~rd Nwoser)
i, ~ c R,~.~- ST . LUG 1 E Councr. Floriaa,
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and tAis atatement is to De takea u uq? deeLration o! citiunship. actual bgal residenae and domie~e in the State of Florida.
IF FOR THE PURPOSE Of ENROIIING ~ If FOR IiQMESTEAD PURPOSES~
CNII~REN IN SCHOOL~ PLEASE STATE PLEASE CHECKS ~
THEI NANESS -
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~ i i /i p ~t ,f~ LEO ANO RECORpEO
~~.LUCIE ~OUNTY FLA. ~
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~ ~/~~it ~.f OD/l CLERK C~~CUIt COUAT
AFCC~~a VE~IFirO~..~..~
w t-=~-'~ I~cc 2f~ 9 oz ~'75 _
~ 3~54&~
I I~'URTHER CERTIFY tfiat I will register at r.~y local address when the registration booka reopen. and eomply with all
other requircments ot a legul resident ot this State.
I FURTHER CF.RTIFY that I have rio intention to return Lo my lormer domicile. and I intend to remain in
• , ST . L U C 1 E~ , Co~nty,
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' ~ Syy6,rn~o, pnd subseribcd before me this day ot r / ~ ~ ~ ~i{ o ~2 / Jl /f~
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. A.D.19 7~
! RQGER . P01 AS: CLERK OF C IRCUI T GOl~2T
= ST. LUGIE GOUNTY, FLG2IUA .
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