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Deciarat~on of Domici~e and Citizenship ~ `
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TO TtIE CI.ERK OF TH~ CIRCUIT CUURT.
ST. LUG 1 E ~pUlv'~y~ FI,pRIDA;
TAi~ h my decluratiun oI Domicile and Citizensbip ia the Stete ot Florida th~t I am fiGng this day ia sccordance, and in ~
contormity with Section 222.1T, Florida Statutes.
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I wu to~m~rly a legal resident of _ a-~- 1~2 w. D~o,.~ ~ ~ Q,,,~ yo r k ~ I
. ICity) lState)
resided at...~(~b _ kik~ S tl+ << Y-- However. I have chunged my domicile to `
(Stre.s aad NuauDer) , - ~
and am and have bcen u bone fide resident ot ihe State of Florida sinco -~'~~-b~-v a~~ day of '
s<~ d e.,._ !o f .19 7~. aad 1 reside at _/O B Sa ~ Y H / 9~`' ~ o~ v 1~-
(Street and Number)
_ ~ t- ~ e,rc S T. L. UG I E County, Florida,
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and this statemenl 'u to be takea as my declarstion of citizenship. actual legai residence and domicile in the State ot Florida.
Ii' fOR 7HE PURPOSE OF ENROLLING IF FOR NOMESTEA~ PURPOSES~
CNILDREN IH SCHOOL~ PLEASE STATE PLFASE CHECKI ~
7HEIR NAMES:
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. OCT Z I OSPM ~I~ ~
418849
I FURTIiEit CERTIFY that I will register at my local address when the registration books reopere, snd comply w-ith all ~
other requirements of a Icgal cesident of this State.
I FURTHF.;~ CF;RTIFY thr.t I have no intcntinn to return~ to m fnrmer dnmici!e. and I intend to remain in
Q-. r- s~-- T. U C 1 E County
IC;t~I . ~ ~
Florida, permancnti; .
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Sw•orn to and suhscribc~d beforn me this day ot ~o ~'4- ~i F r e T ~/a v~~t 3 3'/Sp t
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ROGER P01 TRAS CLERK OF G IRCUI T COUF2T
ST. LUCIE COUNTY, F~041UA ~
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EPUTY LERK $OAIf~ '
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