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TO T1iE CLERK OF T11E CIRCUIT COURT.
ST . L UC I E~ CovNTx, FLORm~:
This is my deetaration of Domkile and Citizenship is the Slate of Florida that I am filing this day In accordance, and In ;
conformity with Section 222.17, Florida Statutes.
~ IV 4 f0 /1/ 1 ' ~ 19- S S and I i
I was tormerl a legal resident of ~ L {
1 71 (Ststa) e
iesidcd al U N LSp.~4,L'Q . However. I have changed my ,domicile to
(3tre~ and Nwaesrl -
and am and have been a bona fide resident of the State of Florida since ~ i4 ~ ~ ~ ~ -day of
19.~ and I reside at ~ ~ h ~ R f1S 0 ~ 19 ~ ~
(Sttaet aad Nuaiperl
. ~ ~ ~ L .e _ ST . L UC I E County. Florida,
(Cft71
and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF~FOR HOMESTEAp PURPOSES,
CHILDREN IN SCHODt.a PLEASE STATE PLEASE CHECKS
THEnI
R /NAMESS
C - / 1 t ;I t' ~ • ~ U N t~ ~ 'FtLEO ;.':D RECORDED
~J~~r ~~UtiTY. fLA.
~ v h Un ~Un
. - *79 J~,~l Z2 AM 9:42
.
I FURTHER CERTIFY that I wdl register at my local address when the registration books reopen. and comply with all
other requirements of a legal resident of this State. - -
I FURTHER CERTIFl' that I have no intention to return tom former domicile. and I intend to remain in
U C 1 E County.
Gtr)
~ Fbrida, permanenti~ .
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Sworn to and subscribed before me this ~ ~ day of / t L~ /2 G
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x .A.D.19_
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R ER OI AS .ERK F C R~~ ~ (ry4J~2T
-
ST. L IE COUNTY, Ft_ 1VA~:= _
. • ~ i.- .LJ ^ ~
BY. _
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