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Dectaration of Don~iciee and Citiz~~ship '
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TO TtIE CLERK OF THE CIRCUIT COURT. ! 3~ G~ ~i
ST. LUC I E CpUNTy, FLORIDA:
This is my detlarntion ot Domicilo snd Citizcn~hip in the State oI Florida th~t I sm fiGng this day ia accordance. and in
tontormity with Section 2~.17. Florida Slstute~.
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. I~vu (ormc~ a legal resident of "-s•~ ~ ~ and I
IGtyl lState)
resided at ~ ~~iowevoc. I have changed my domicile to
(Stn~t aed Numbstl / •
and am and have bcen a bona fide re~;dent of the State of Florida ~ince ~'y day of
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~ ,19~ and I nside at ~ ~ ~
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ST. LUC I E County.Florida,
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and this statement is to be taken tu my declaration of citizen~hip. actual lega) residence and domicile in tho State of Florida.
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If FOR THE PURPOSE OF ENROLLING If fOR HOMESTEA~ PURPOSES~ ~
CHiLOREN iN SCHOOL~ PIEASE STAYE PLEASE CHECK: ~ ~
THEIR NANES:
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~ FILE~ ANU ~ECOROED
ST. LUC!"t i.OJNtY FLA. 1
Rv~,f.~ P"vl'itAS
f REC~~n YEF~ "EO cou_,_,R~.
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I FURTIiER CERTIFY that I will register at my locsl address when the registntion books rcopen. and comply with all
other requirements ot a Icgal resident of this State.
I FIJRT~iE~CERTIFY that I have no intcntion lo return to my former domicile, nnd I intend to remain in
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Florida. pernranenti; .
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Sworn to and subscrihed be(orc me this _p,.S.~ day o[ ~
--~~/1_~ z~ ~~c. ~ . A.D.19 7G _
~20GER PO i TRAS,~ CLERK OF G I RCU I T COU2T .
"ST. Lt1C I E COUNTY, F LOR i UA •
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CF'UTY LEHK
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