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TO TtIE CLERK OF TFIE CIRCUIT COURT.
ST. lUC 1 E .CpV~y. ~,OftIDA:
• Thu !a my declaraiion ot Domicilc ~nd Citizenship ia the State ot Florida thRt I am filing this day tn secord~nce. ~nd in
conformity with Scction 222.1T. Fbrida Statutes.
I~ras tornnerl a legal reaident ot 1~.1U ~ and I
~cur~ ' . ~ ~
e~esided at L~ ~S ~ Hoaever, I have ehanged mr domic;lc to
(StrNt ~sd Numb~~1 . >
and am and hs~ e been a bona f?de resident ot the State ot Fbrida sinee ~ dar of
~ U L 19 and I reside at ~~C>> 1
~~r~_ , ST . L UC 1 Esc,..c.aa tv~~
Countr. Florida.
and this statement is to be taken i+ my declaratioa ai citiun~hip. artual lega! re~idence and domicile in the State of Fbrida.
IF fOR THE PURPOSE Of ENROLIING IF FOR HOMESTEAD PURPOSES~ "
tNIIOREN 1N SCNOOI~ PLEASE STATE PLEASE CHECK: ~
THE I R NAF!ES:
_~rp~~~~ _~t. ~~I ~
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~ fI~EO ~NO RECORDED $
ST.lUC1E COUNTY FlA
ROCEP. PpITRAS
c~ ra~ c::~cui~ co,~-
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~ ~ .Jny 10 12 oi PH'18
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I FLJKTNER CERTIFY that I w~71 register at m~ loc~J addrese ~rAen thc registration books reopen, and comply w~ith a!l
other requirements of a legal cesident of this State. ~
~ ~CE_R~ thst I hnve ao intention to return to my Iormer domicile, and I intend to remain ~in
I FUR C~ I I"! ~ P_ , S T. L u C I E . County,
(Cit7) . .
Florida. pecmanenti; .
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Sw•o to and subzcriAed bcfore me t~u ~ a~r or
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` --'t t l<~ G A.D.19~, ;
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~s ~GER POI Tf2AS1_ Cl_ERK OF C tRCUt T COl~2T
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c~ ST. lUG I E COUNTY, Fl.OR 1 UA • ~
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415
~ E P U T Y l E R K ~~O ~'AGE
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