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` ST,._IUC,I C .COUNTY, FiA1tIDA:
This ts n~y decleralion of DomicilU and Citi~.enship in lhe Stato ot ~'lorida that 1 em liling this day in accord~nco. and in
cuniormity with Section 22..''.17~ Flurida Statutes.
I was furmerlv a ic~al residrnt ot H1axr en sburg _ New Y~tk rnd l
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residcd at 8 Mouiltait'1 AVe. - . Nowever.l hsvo changed my domicile ta
- (St*e~t and Number) .
and am und hqve bi.~en a bona tide rexident of tho Stntc ot Florida ~ince ~?l~Ch 1 5t day ot
MaYCh ~ 19~8 , and I reside at ~s~` N.E~ Solida Dr/
. lStesc~t and Number)
- 1'07[ t St . Lu~e _ ST . L UC I E Coun~y. Florida,
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nnd lhis stutement is to be tal:en as my declaration oi citi~enship, ~ctual legal residence end domicile ia the Stato of Fbrida.
IF FOR.THE PURPOSE OF ENROLLING If FOR HOMESTEAO PURPOSES~
CHIlOi:EN IN SCHOOL~ PLCASE STATE PLEASE CHECK: ~
TNE IR NA~tESZ
. . _ :,':J i:ECORDED
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43184~
~ • ~ ~ 'i9 ~ 24 P~1 3 : 42
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I FURTI~ER C~RTIFY that I will mgister at my 1oc~l address when the re~ristration books reopen, and comply w•ith aU
' other rcquircments of a legal resideni of this State.
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I FURTHF.:2 CF.RTtFY that I have no intrntion to return to my former d~~micile. and I intcnd to remnin in
JY . L U C 1 E . Couniy.
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~ Florida, permanenti;.
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S«•orn to end subccribed before me 1l~is ~ day of D ~ ~
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A.D.19_ ~ _
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' RO P41_TRl?S LEF:K OF C IRCUI T COlk2T
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