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' 431399
TO TIIE CLERK OF TILE CIRCUIT COURT.
ST. lUC I E COUNTY. FLORIDA: \
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this.day in accordance. and in
eontormity with Section 222.17, Florida Statutes.
I was formed a legal resident of f Asa _ _Ar i z ona and I
icily) IStatel
resided at 202 1\'. 54th . Street - However. I have changed my domicile to
lStroet aad Nnmberl
and am and have been a Long fide reaidont of the State of Florida since 15th . day of
Dec' .19 ~8--andIresidoat 1~J50 firi nidad Avenue
(Street aodNumber) -
^t. Pierce ST. LUC 1 E - County. Florida.
ICttyl -
and this statement is to he taken as my declaration of citizenship. actual legal residence and domicile in the State of Florida.
IF fOR THE PURPOSE OF ENROLLING IF FOR NOMESTEAO PURPOSES,
CHIt.DREN IN SCHOOL, PLEASE STATE _ PLEASE CHECK: ~X~
THEIR .NAMES: ~~-~-~-J~
- FILED AIID RECORDED`
- : tiCIE ~CUP:TY. Fl_A.
431399.
,79 J 19 . PM 12:3 3
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CLARK ~iR~.%'T :.:~~.:'rZ!
I FURTHER CERTIFY that I wiU register at my local address when the registnttion books reopen. and comply with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ ~ i . ~ u ~ ~ ~ .County.
lltit7l
Fbrida, permanenti; .
g .f fr'~,,! ~ mil, Z,v~ k
- ~ d c7
• - : i, -
- IName)
,Adore,,, ~ 3~
Sworn to and subscribe) before me this _....LL_ day of
T ~
t
ROGER POI TRAS. CLERK OF CIRCUIT COURT
. M_
ST. IUCIE COUNTY, FLORIDA ~ -
8Y :
EPUTY IERK
• B!}CK3Ui s,~~~740
i AGO Form 7{-22 •
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