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• 4;~6455 ~
•ro ~r~iF r.t.r:i~x o~• ~•t~~: CIRCUIT COURT, •
~ ST_ L.UC.1_E._~ CouN~. FIA1t1DA:
Thi4 is m~ Jc~claration of I)auilcilc and Ciiixc»st~ip in the StAto ot 1~'torid~ thal 1 arn f7ing this day in accan~lnncc. and In
s
contormity witle Scetion ~t.'..I7. 1~'lurida Sixtutes. ~
1 t
l N•:?s (o~m~rl~• d~CE;dI ttrs+dcnt of ~ 1. t f~ a~ ~ V1 and I ~
. ~ ICity) IState) ~
nsidcd ~l 1
~~~ti~~ ~ M S~~1 ~.12~i . Nowcvor. I havic ehan~cd my domiciic to
(Strret and Nwubcr) ~
an~l am snd ha~•c b~cn a bonn Cde residcnl af the State ot filorida sinec e ~ ~ day ~t ~
~
~
T , ~9,2~.:?nd l rc~;c~c nt 6~ S. c_ /?o ~.C f~ /a d f~ ~
~ ~ (Street ~nd Tlumber)
~
` v ~2 r S~-: ~1~' C~ . ST. LUC I E County, Flvrida~ t
tC+ty1 ;
and this st~sicmcnt is to t~ taken as my dccUrntio~ oi citizcnship, ~Nual icgal residence and domitile in the Stato ot F'loridn. ~
~
IF F'OR TItE PURPOSE OF ~t1ROLlING Ii' FOR FiOMESTEAD PURPOSES~
CHIL~Rt"N IN SCHOUL~ PLEASE STATE PLEASE CHF:GKi ~
1'KEiR 1~/IMES.
i :_t::l :?_COR(~~0
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4~455
'T8 Dr~ ~ P~1 ~2 ; 39
. . . 9~~
~L-:.r:
1 FURTIiF.R CERTIFY that 1 w~11 register at my local address when the registration books reopen. and comply with al!
other requir~^ments of a lega! resident of this Stale. . _ -
I FURTIiF.:t CERTIFY that I have no intcntion to rcturn to m~ former domicite. and I intend to remain iu ~
-j- b~, c~ ~ . U C 1 E ~ . County. {
~
lCitrl .
filorida, permancnti;.
~ C~ U~Ty
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vt/`:r,'a,;~.~:a.~~ ~ INune)
7 1Addee.r)
Sw•orn to and subsrrihrd before me tt:is day of / ~ s- L• N O e K o~ 5 u fi
__.___'~~..~ri _,(~-v~- 8 ~ S T L, ~ c,
n.n. ~s.
R~~ER P01 TZAS~GLFRK nF" C IItCUI T COl~2T
ST. lUC I E COUtJTY, ~~OR tUA ~ .
E~Y : ~
IF:PUIY ~!_}tK ~ -
~ . ao<<.299 ya'~ ~
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