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Deciaration of Domicile and Citizenship
~ , 3~~~95
TO THE CLERK OF THE CIRCUIT COURT.
_ ST. lUC I E COVN'1'Y. F'1.oRIDA: _ -
This ta my declarat[on ot Domlcile aad CitIr.eaship in the State ot F'brida that I un ~'iL'ng this dq ia accordance. and ia
eontormity ~rith Seclioa 2?2.17. Fb~ida Statutes. . ~
I wu for~ a kgal resideat ot C~~~ ~ I
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resided at ~ Ho~rever. I!u?ve ehsnged my domicile to
18tre~t aed Nwr~1
and am and have beea a botia Cde e~esideat of the State ot Florida sinee ~ dar oi
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18_7~__, and I nside at =
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~I~,~c~-can~ ~ o-~.~ ~a~h _ ST. LUG I E '
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and this statement is to be taken u my declaration oi eitiunahip. aetual kgal residence and domic~e in the State ot Florida. ~
If FOR THE PURPOSE OF ENROtttNG If FOR HOHESTEAD PURPOSES~
CHtLOREN IN SCHOOt~ PtEASE STATE P~EASE CHECK: j`~7~
TNE 1 R NAMES. ~ ~
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1 FURTHER CERTIFY that 1 w~71 register at my tocai addrecs when the tegistrution books reopen, and rnmply writh all ~
other requirements ot a legal resident ot this State. ~ ~
I FURTNEI; CERTIF'Y that I have no intrntion to return to my tormer domicile. and I intend to remain in ~
' ST . L U C 1 E . County.
ICit~) _
Fbrids. permanen~i; .
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SHOrn to and ubscribed before me this dsy ot _g ~ 2 A ~~Q~.n.~ri~_,~p.c 1~ ~A.~lQ ,
' . A.D. l9 / - -
ROGER P01 TRAS. CLERK OF C IRCUI T COURT
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ST. LUGIE COUNTY, FLOC~IUA ~
BY: " ~R.~.
~PUTY LERK
e~PK 244 ~~~~F ACO Fnrm 71 2l
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