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TOTfIE CLERK OF TNE CIRCUM' COURT. . ~ . ' :
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• ST. Ll1C 1 E CpUtv~t'~t~ ~LpRIDA:
This i~ mr dcclaration of Domicila and Citizcnship (n t~e State ot Florida th~t I a~n filing this d~y i~ aecordance. and in
conformity with Scction 2~.1T, Fbrida Statutes. ~
I wu fonr~~rl a Icgal reside~t ol :1 P~ - ! ~ ~ and I .
~ ~ ! (Citrl IStat~l
residcd at f~ ~-l i:~~'!~'i' ` S ~ ~1! . Nowever. I h~va changrd~my dosnicilc to ~
IS and NumDe~)
and am a~d havc been ~ bons tide re~ident of thc State oI Plorida since day o!
~ C ,~:.Q--- --19~ and I residc at y ~ "5%:- ~ ~1 '!'~-~tf s~ ~ ~ ~ ~T
, ' _ (Steeet wd Number)
~r ~ L ST, lUC I E County, Florida,
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and this statement is to be taken u my declaration ot citizen'ship. actval legal re~idenee and domicile in the State of Florida.
If FOR TNE PURPOSE OF ENROLLING IF fOR HOME57EAD PURPOSES~
CHILOREN IN SCHOOI~ PlEASE STA7E . PIEASE CHECK: ~
; - THEIR NANES: ~
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I FURT}IEFi CERTIFY thAt I will register at my,local addre~s when the registration bDOks reopen. and comply with atl
other requercmcnts of a 3c~a1 resident ot this Statc.
I~jURT,IiE3, GE:it~Y that I have no intrntion to return to my tormer domicile. and I intend to remRin in .
1 G--~'" k~f' L~ L` ~ S T. U C t E . County.
ICityl .
Florida, pcrmancnti; .
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$worn io and s~bscrib~~d hrfore mc this day of v~ ' C f.
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c ~v1 • .A.U.19.78
RnGER POI TRAS f.LERK OF_C IRCUI T COURT
ST. LUGIE COUNTY, F~ORtUA ~
E3Y : ~,,~,.~a .
. EPUTY LERK ,
. . ~ ~'~~~293 PACi i?6
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