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Declaration of Domicile and Citizenship ~
• 4;Z?7951
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• TO THE CLERK OF THE CIRCUIT COURT. - = E
mot., M
• ST. LUG I E tAUNTY, FLORIDA: ~
This b my declaration of Domkile and Citheaship in tM State of Florida that I am filia= this day is secordana. and in
conformity with Seetioa 222.1T. Florida Statutes.
I was fob a legal resideat of R Ve N=
n=:.---- and I
ICity1 tSu?te)
resided at 6 Radcli ff a Avenue _ . Howwer. t have changed aV domiede to '
l8t*eK ~ Nueberl .
and havebeen a bona iide resident of the State of Florida since Firs -day ~
and am
July _19 78 _andIresideat 4 Santa Cruz Wav. Soani b Y--~1cPC A-
- • lSte+et ud Nreb~H
Port St . Lucie ST, lUG i E County. Florida.
t(~41
aced this statement is to be taken as my declaration of citi~snihip. actual legal residence and domicile ;n the State of Florida.
Ii iOR THE PURPOSE OP ENROLLING - Ii iOR HOMESTEAD PURPOSES
CHILDREN IN SCHOOLa PLEASE STATE PLEASE CHECK:
- THEIR NAMES: f
,
€
- 4~'l951
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I ~ CERTIFY that I wi71 register st my local address when the registration books reopen. a~ comply with all
other reyuinmenta o~[ a legal resident of this Stata. - !
~ I FURTHER CERTIFY that I have ao intention to return to my former domicRe. and I Intend to r_maia is
` Port St. Lucie ST . LUC 1 E -County.
6 ICd~I
Florida. permanentl; .
_
\GOUIdTy~~ .
~ .11i9 S Zvi Ey
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C~~F~
(Nuod
4 Santa Cruz Wav. Sp. Lks R_ F-- -
lAddess)
t Sworn to and subscribed before me this __,L:~L-day of Port St . Lucie , lorida . 33452
~ /
_ C O~fu_
.t . A.D.19. ~ 8
ROGER POITRAS CLERK OF CIRCUIT COURT
ST. LUG I E COUNTY, f LOR 1.UA -
BY: ~ ,
- JE UTY LERK ~ ~
' LGii1i ~ DACE j.~
AGE Fnrm?1 ~