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~ Qeclaration of Domicite and Gitizenship ,
. ~1529'7 ~
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„ ~ TOTtiE CLERK OR THE CIRCUIT COURT. . ~ , ' ; ~
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ST. LUC 1 E ~p~Ty~ FI,ORIDA:
Tt~is b my dcctaration ot Domic?~e and Citizeaship in the 5tate ot Fbrida that I aa~ fiting this dar in aceordance. and In
toafocnait,p with Settion 222.17, Fbrids Slatutes. _ ~
I w?as torn+~rl a kgal r~sident oI lV~ c~ /'r~ e~e L L~ L!~~~ aad I
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m~ ~,t 7 3 f~ /n~Q. L fi~-J~'~ A,~ - Howevcr. I bave changcd my domieile to ~
IStr~~t and Nnm~l
aad ua and heve bceri a 6ona Cde nsident of the State ot Fbrida ~irne _ ~y a~
/3 LJ Cl S ~ _ .19~ aod I reside st ~ ! / i~ ~E' S ~C' /li ~
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FD ~ 7?~ S7'~ ~ L v_/~P _ ST. LUG I E Couney. Florid.,
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and this statemeat is to be taken u my detlaratioa ot eitiunihip. actud legal r+e~ideace and domicile in tbe St~te ot Ftorida,
If FOR 7HE PURPOSE OF ENROLLING IP POR HOMESTEAD PURPOSES~
CHILDREN IN SCHOOI~ PIEASE S7ATE PLEASE CNECK: ~
• THEIR NANES2
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I FUR'fIIER CERTIFY that I will registcr at my lacal addccsa rvhen the registration books reopen. and comply with all
other requircments o( a le~al residenl of this State.
I FURTII~:t CF.ijTIF'Y that I h~tvc no intrntion to retorn to my former domicik, and I intend to remain in
r~d „•f Sf L vC' ~ ST. LUC 1 E .County.
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F{orida. permancnti; . ~
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Sworn to and subscritK~d betorc me this day ot P~ / ~ G~ /'Q ~
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ROGER P01 TR~SJ CLERK OF C IRCUI T COU2T
ST. LUCIE COUNTY, fLOftiUA ~
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