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Deciarat~on of Dom~cile a d C t e s p
414931
TO TIlE CLERK 0~ THE CIRCUIT COURT.
ST. LUG 1 E CpUNTy~ FLORIDA:
Thb is my declaratien ot Domtcile and Citise~sAip Ia the State of Florida that I am C~lin~ this da~r in seeocdaace. and in
eoniormity with Section 222.17~ Fbrida Statutes. , .
~ • .
I~vas formerl gai restdeat ot _ and I
1at71 ISt I
resided ~t ~ Nowever. I have ehanged m~r micile to
(8tre~t ud Num~r) ~ ;
and un and 6ave beea a bona Cde resident of the State oi Florida siaee ! day o(
,
18 ~ snd I reslde at '
18tee~t a.d Nuo~~e) ~
ST. LUG I E Couucy. Ftorids. ~
l(~t7) ~
and this statement is to be taken u my deelantion oi citise~~hip; aetual legal reaidenee aad domicik ia the State of Florida. ;
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FOR THE PURPOSE OF- ENROLL ING I i' FOR HONESTEAD PURPOSES~
CHIL~REN IN SCHOOI~ LEASE STATE PLEASE CH~CK: ~
THEIR NAMES.
.y ,~dis
LvC1E CO ~CORUED
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ROCER PO~tR~c
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A~^ 15 10 s~ AN'T~
- ~ 414931 ~ ~ -
I FURTIiF.R CERTIFY that I will register at my local address when the registcation books reopen. and comply a~-ith all
other requirements of a legal resident of thi~ State. '
I FURTIi CERTIFY t~ I ave no intxntion to return to my fortner domicile. snd I intend to rcmain in
LuciE
~ ~ $T . . County.
ICit~) .
Fbrida. permanenti~. ~
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Sx•orn toan .[ore me this v~ ~ day o[ ~~r ~~t~~~~~ ~ D/P~~J4'
. A.D.19. 7 S .
ROGER P01 TRAS~, CLERK OF C I RCU I T COI~tT
ST. LUCIE COUNTY, FLORtUA ~
B,r: - ~ -
- EPUTY LERK R ~ ~
SOOK ~ P~ICE
AG(1 F~~rm 71 •
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