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Dectaratian of Dom~cile and Ci~izen~hip ~
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TO THE CLERK OF TNE CIRCUIT COURT. ~
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ST. LUCtE ~ ~
CdUM'Y. FLORtDA: ,
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Thi~ b mr deeluatton ot Doen~cila and Citiunship la the Stat~ o~ Fbtida that I am fillna thL+ diy ia seco~dance, and in `
eonlormitr with Section ?~.1T. F1orlda 5tatut~s. - ~
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~ I ~?as farmrrl a legsl resideat ot ~ G G and I '
7 ( I~tst~1 f
tssided at ' Howewr. I Lave changed mr domicile to `
Iste~~t ~ed N t
and am aad have beea a bons Cde resideat ot the Sta ot Florida ainee ~ day oi ~
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;~~/~-6vL~it./ 19
~ind I resId~ at l~~ Ec ?)~~~~~L~~Y~ / r t
` . • (StrMt and Numbul
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h! , ST. LUC 1 E Couaty. Flocids.
- and thia aLtemant is to be Wcea a.s mr declacatioa ot eitiuns'hip. aetual kgal reudeaee and doaueile in tAe Stato ot Florida.
Ii•fOR THf PURPOSE OF ENROIIfNG IF iOR NOMESTEAD PURPOSES~
CH1l~REN IN SCHOOI~ P1.EASE ~,4TATE ~LEASE CHECK: ~
' 1H R NAMESS~L
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fILEO aND RECONOED
ST. tUCiE COUNTY F~~.
ROCER POITR~S
~'-~'K C=+?CUST CC R
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Ma~ T 12 31 PH'1~
39~60~i
I FURTHER CERTIFY ihat I w~71 register at my local addres~ when the regi~tntion boolc~ reopen, and :omQly .vith all
other requirement~ of a legal resident o[ this State.
FU~t';'HE3 ~C R,TIf'x thst I have ao intention to nturn to my former docnicile. and I intend to remaia in
i -.iC~ - /1 f C N_ l.r _ S T. L U C 1 E .~~ty.
(Cit~l . ,
Florida. Permanenci; .
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Sworn to and subseribed betore me this day o[ ~G ~ ~ ~ • ~ ~ ' ~ ,
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ROGER P01 TRAS. CLERK OF" C IRCUI T COUFtT
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ST. LUGIE COUNTY, FLORtUA •
BY s F
P ~ T Y L E R K ~o~K 2~3. ~a~~ 375 ~
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