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t~eclaratior~ o~ Domicile and Citizenshi
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TO TNE C~.ERK O~' THE CIRCUIT CQURT, i
32~~ 1 ~
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ST. LUC 1 E ' CpLNT'Y, FLOAIDA: _
This is my dectaration of Domirik ~nd Citiunship in the State ot Fbrida that I am Gling this aa7 in aecordance. and in
aoatormity with Seetio~ 222.17~ 1~'lorida Slatutes.
I~ru formerlY a kgal resideat ot ~l'- m r,,,~rQrL ~_~G u~ a~d I .
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resided at ,L . Ho~rever, I have changed my domicile to ~
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snd am and have beeA a Dona tde resident ot the State ot F'lorida since ~~G ~ da~ ot ~
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,19~..~. and I reside at C:~f
Ct ! 1'1111 ~
(8tre~t aed Numberl
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e~'~ _ ST. LUC ! E County. Flo~a..
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and this statement is to ba taken u my deetantioa n~ eitiunship. sctud kgs) nsidence aad domi~ik in the State of Florida. ;
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IF POR THE PURPOSE OF ENROI,ItNG Ii POR HONESTEAD PURPQSES~ ~
CHILOREN IN SCHOOL~ P~EASE STATE PLEASE CHECKS ~ ~
THEIR NAMESS ~
~h,~~'~ ,~ti~ /ofla.~~.~ U11.'/~s
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fILEO ANO 11ECOApEe
~ ST. LUWC COUMTY fLL
~OLEiI ?~1TRAS C~ ~
Ct£RiC C~z:,iltT COQRt
RECORD YEiiiF1ED
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3242 ;1
. t FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply aith aU
other requirements ot a lega! resident of lhis State. ~
I FURTHE~ R IFY thsi I have no intention to return to my former domieile. and I intend to remain in ~
~ ~ S T. L u C~ E . County.
ICit . ~
Florida, permanea~i~ .
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Sworn to and subxribed be(ore me this day ai ~
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' A.D.l9 7fi
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F~OGER PO ! TR S. CLERK OF C 1 RCU 1 T COU2T ~
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ST. LUCIE COUNTY, F~ORIUA ~
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EPUTY LERK +"yt ~
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