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T011{~: CLE:Itn 01"fli!•: CIRCUIT GUUIi,
ST, _ L UC 1 f COVhT~', F 1.olut~A:
• This is m~• dcclnrltio;~ of Domi~ il~ end Citizcnship in thc Sttto c.' F'tucida tAat I am filing this clay i:i ncc~xJnnce, cnd in
tonlor:~~it} v?~ith Sccti;m 42''.t~. Flurida Stetutc~,
I wes form~rlY a t~•ga! re~itl~nt ot i'e s tWOOd ~ I l llt;oi s _ and [
. tcicyl Isc.c~)
residcd al 57C !:d. ~ c`~ t.; $t . , Nowever~ I hsvo ehsnged my domicife tu
(3trect and NumDer)
and am and hs~c bcen a Lvna tidc residcnt of thc State o[ Fi~rida since 1st dey ot
_ i~:arch ,~9~1 , and 1 resi~e at ?~1`? I:ornin~side c31.
(Street ~ndAiumDerl
Port 5~ Lucie, ST, lUC 1 E County, Flo~da,
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~ a~d this s!a!rment is to Ge taken a~ my d~elnratiun ot citi-rnShip. actual Icral residence ar.d domicile ia th~• State ot Floride.
If FOR T11C PURPOSE O~' EFtROILING If FOR NOMESTEAD PURPOSES~
CFi t I~REN 1 SCIIOOL~ PLf ASE S7ATE PLEASE CNCGK:
71{C 1 R NANES: ~ ~
F?;EG AM~~ R~CUR ~
S1,Rb~ir^.C~~liiy Ef;
CLEAK Cla?011r~,~$ ~
~ AECURC y~Fl~f
pt ~OI;RT
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~ 36Q262
I E'Z'{:TitT:F; CF.KTiz'1' tt:~t 1 wi11 re;;i~t.: et my local ~cdclr~_ss ~+~1,er. the regititralion b~ks rec~prn. r.n ~ eor.~~~ly wi;h a{I
othrt rcyuirc:.:, i2Cti G~ R It'~;s{ ff'Sla~r~nt o: tt,i•, ~,a:c.
I FUI:T1[E::{ Gt:R1'If"! th::t i ha~c r.c in~~•~,ius~ to rrtu:n to rny k~rr.~e~ do:nici!c, and I intcr.d lo rc~nain in
• Ycrt St LucieL____ ` , ~t l. uc ~ E
- - . CounLy,
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~19_~iornic~~„-,side 31.
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Swu:;: to er:~l ~u' ~•.ri~ ~•d ~;.,rc r:.~ t?~ia l v dny o! Por L:~ ~ L~ci e, ~'la• ~3-- jc
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