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TO THE CLERK OF T11E CIRCUTf COURT,
ST. l. UC I E ~,o~nA:
• Thia l~ my dcclaration of Domicile and Citizenehip ta the State ot F1orida that I am filIng thu d~?y in accordnrco. and 'en
oontotmity witA Scttion 2~.1T. Florida Statute~. •
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I waa farnnerl a legal reside~t oi ,~~~-L Z'~~ -~-~-L'~~= . ~l1-'~f~ ~ and I .
/ 7~ .(Ltiey) ' ~se. )
eesided at G' ` -L G~ --t=~= How~evec. I have chaaged my domicile to ~
and Numb~H , }
aed am d have beea a bona fide nsident of the State of Fbrida ~iace f% ~ day o!
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" 19~~ and I nside at ~i~'-/' ~~C
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(Stewt aed NnmDal
~ ?-l .-c-~„- ST. lUC I E Co~ocy. Fbrida.
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- sad this statement u to be taken as mr decluation ot citizen~fiip. actual legal re~idence and doaticile in the Stat~ of Florida.
IF FOR 7HE PURPOSE OF ENROLLiNG IF FOR HOHESTEAD PURPOSES~ '
CHILOREN IN SCHOOL~ P~EASE STATE PLEIISE CHECK: ~ ;
THEIR NAMES:
FILED AND RECORDED
ST. tUCiE COUNTY F14. -
_ QOCEq P~)ITRAS ~ '
. CLERK ;,IRCUIT COURT
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~AN I(I 3 23 PH'7~ :
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~ I FtJRTHER CERTIFY that I will register at my (ocal address wAen the rcgistration books reopca, and comply with all
~ ott~er requirements ot a leg:il resident of this State.
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~ I FURTHE:t CERTIFY thst I have no intention to return to my former d01~11p~!', aad I iate~d to remain in
~ ' _ S r. L u c ~ E , County.
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Florida. permanenci; . ,
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Sw orn to and sahscribed betore me thu __..,L
° day of ~ -fL ~ ~
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~ -~~''Y'"`c~v`~-t . A.D.19 ~
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ROGER P01 Ti2AS, CLERK OF C IRCUi T COl~2T
_ ST. LUC 1 E COUNTY, F1021 UA •
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