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Declaratian of Domicile and Citizenshi~ ~
TO THE CI.ERK OR T~iE CIRCUIT COURT. ~
ST. LUC I E CpUNTy~ FI,pRIDA: .
Thia is my declsration of Domicik and Citir.enship ia the State ot Florida that I sm filing this day in aetordsnce, and tn
tontormity with Sectioa 222.17, Flocida Statutes
I was IormerlY a lega! r~aident ot ~ and I
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cesided st ~7"~~ 1~=- - However.I have ehanged my doanicik to
(St»~t aod NnmpsN
and un aad have beea a boaa Gde resident of the State ot F'lorida sinee day of
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19~and I reside at ~~J ` _ ~-s'~l ~U' - ~
' r .S~ G~c.-~- ST • LIIG I E~.oaN~e.rl
Couaty. Florida.
aad tius statemeat is to be taken u my dectuation o[ eitiuaship. actual legal nsideaee and domicile in the State of Fbrida.
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If POR THE PURPOSE OF EMROLIING IP FOR HOMESTEAD PURPOSES~ ~
CNIIDREN IN SCHOOL~ PLEASE STATE PLEIISE CHECK: ~
THE li~'l~A~IESt ^
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~ c~ ' t~:EU AY~ P~~JRDED
f ST. lli. ~F' ;;OiINTY F~A.
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iTFURTHER CERTIFY that I will register at my local address when !he regisiration books seopen, and comply with all
other requirements of a lega! resident oi ihis Slate.
1 ~TH ERTI thxt I havc no intention to return to my former domicile. and I intend to remain in
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(CitJl . ~
F{orida. permanemi; . ~
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Sworn to and sabscribed belore me this dny of / -'L.1-L ~
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06 ~ POI TF2AS,,_CLERK OF C IRCUt T COl~2T ~
S~c;,ci ~:t~ COUNTY, FLOR 1 UA ~
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