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ST. 1_l~ 1 E c;ovtrrY, F•uottiuA: ~
This i~ my decl~rntion of DomiciCa and Cit~cnship in thc Stato o[ I~'iucidA tliat I am filiag thLt d~y In uccordance. and in i:
conturmily wiih Section':,~.I7~ Florida Stelutes.
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I N•ns formcrlZ a Ie~AI rnsident ut ~ ~~W ~~d G" ! f~ , L G~_.._!
~ind I :
_ _ ' ICity) IS~ate1 ~
msidcd ~?L ~ " U ~ ~ ~ / ~ ~k'~~G I owover, I have ehanged my domicile to ~
($trcel ?nd Number) ;
and rm and havc bcca a bone rdo tcsidcnt ot the StA1,~ ot Florida eince V vrr3L ~ ~ ~ day ot ~
Iy.~. and i reslde at / 7 C,~ .s d >
,~i (Stewt and Numbee)
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d~ ~ S 1, ~ r/G , ST. LUC i E County. FIori3~,
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and this ctatcmcnt is to be taken as my dectaraticn of citicenship, adual Icgal residenee and domicile in the State of Ftoridn.
IF fOR TNE PURPOSE Of CKROLItHG IP FOR HOHESTEAD PURPOSES~ ;
CNILOREti ik SCli00t~ P4EASE STATC ~ PLEASE CHECi:: ~ ~
THCiR NAN~S2 -
- ~,~~p :(.t:D RECO~REG.
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- 4;L5945
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I FURT1iER CERTIFY that I will registcr at my local address when tl~e registration boeks reopcn. t~nd oompty wiih all -
other requiremenis ot ~ Icgal resident ot tt~is State.
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I F L'RTNE:t CF.RTI~Y that I have no intrntion to ret~~rn to my former domic~le. and I intend to remnin in .
z--~ - _ 1' , U C 1 C ~ . County.
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F loritla, permanenti; .
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R~rER f~I~AS~ ~LERK Cf_CIRfUiT
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ST. l. UC { E COUNTY, F LOi~ 1 U1~ ~
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CPUTY LEi2
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