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4' '460
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7Y) Tfll•: Cl.l;HFi 01~ THL•' G1RCUlT COUItT, .
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ST . L lK I E _ t:OUNT~'. I~'I.OItII) R:
This is my dcclatalian o! ili~micilc nnd Gitir.euahip in the Stete of t'IociJA thal I am fiting this day ih Accordanco, and In
cunfurn~ity ~vith Srrtiun 2'r4.17. I'loridA Statutes. ~
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1 wss for~r..•ri~ a Icgsl rcsidont o! L° and 1
~ (City) (St~te)
nsidcd al ~r+r /1 ~t ? t , Howcvcr. I hrvc+ changcd m~ dur?tici{e to
(.Ctreet ~nd Num!?er)
an~2 a~n and have Lccn e t?o»a tide residcnt ot the Slate of Florida sinces C!J •Z ~ day of
l~ , l9~ and I reside at , ,
~ - (Steeet~nd uw~er)
~ ~ ST. LUC I E County, F lorida,
(Cit~)
~nd this ~t~ir,nent is to be taken as my declsi-xtion of citizen5hip, actual lega) residence nnd d~micile in the StatC o! Florida,
IF FOR 7HE PURPOSE Of ENitOlll~1G IF FOR NOt~IFSTE~p PURPOSES~
CNIIDREN th SCHOOL~ PIEASE STAi'E PI.CASf. (,HECKt
Tt1EtR NANES: -
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Fi!_~~ :.r:~) ~~~J~?u~G
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- 4~460 ~
~ '78 Q~~ . 6 P~! 2:~ b
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I FURTNI~:R GERTIFY th~t I~•rill re~ister sl ~ny loeal_ address v~hen the rrgistration tiooks reopea. and compty ~with alt
other requirements of a le~al s~sideel of this State.
I FURTHF,:t CFR'PIFY thst J have no intcntion to return to m for~ner domicile. and I intend t~ remain in
~ ~ 7. L. U C I E . County.
(Cit~) .
Florida, ~crmancnti;.
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S.~•orn lo rnd ~ubscrib~. r`~c
rne this day of .
C _ A-D. IP. / ~
ROGER PO_i 7'?~AS, CLERK OF_C IRCUI T COt~2T
St. LlK I E GOU~VTY, f ~04'~ i U ~
f3Y: .
EPU7Y IERK Q F
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