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TO T~IE CLERK OF TNE CIRCUIT COURT.
ST. lUC i E CpUIV'1'y, ~•I,pRIDA:
• ThL+ i~ my declaratio~ o( Domicile and Citi~cnship in the Stato oI Florida th~t I am filing thu dRr in aeconlance, and in
eonformity with Seetioa 2~.17. Florids Sktutes.
.
I~ru ~orn,erl a legal nsident at and I
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resided at ~fe ~~~/,~uGK ~a~ _ Ho~?ever. I have ehanged mr domicile to
l9tre.e.ad N~?o~e.N
and am and have been a bona fide resident o[ tlse State oI Ftorida aince P_ C Z? Z7 dar o[
.19-~ 7. tad I restde at ~,ir v/~,~e,l'n r~7.r 4-f /?~/7~j I Lot z.~ y
~sc~.c.aa rr~?e~t
~ ST, LUC I E County. Florid~. .
(pt~)
and this statement is to bc taken a.+ my declaration ot eiL'uemhip. actual legal tesidertce and domieile in the Stste o[ Florida.
IF fOR THE PURPOSE OP ENROLLING IF i'OR HOHES7EAD PURPO ES~
CHIIOREt3 IN SCHO.OL~ PLEASE STATE PLEASE CHECK:
THEIR NANES:'
• FILEO ~NO itECORDEO
$T. LuCIE COUMTI? FIA.
ROCEa PO~TRAS
CtE¢K C«CUIT CO~fRT ~ ~
_ ^ . rE~,~iEO~---
. OEC 21 114~ AN'17
3~635
I FUA1FiER CER; lFY that I wi11 :egis;er at my local address a•hez tne registratioa baaks r~-open, and compty ~,itt~ :..i
othe~ rcquirements of a le~,al residen: cI it~i:; State.
~ •
I F UI:THE;! CE~iTIPY th~t I have ao :ntentic : to re.urn ta my forrr.rr dom.icile, and I intend to remain in
~ JYa LUr.~~ _~iQLli~y•
(CitJ) . .
Florida, perr.~anen*_i;.
GO
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Sa•o,-,^. to er.~3 ssbYCrihcc'. b~•fore r.tic t::i1 day e;
~ CC" A.ti. 19_17
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