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T() TIIF. CLI~.RK 01•' TIlE CIRCUIT COUItT.
ST , L UC I E _ ~ COUNTY. FLORIDA:
This is my declaration of Domicile and Cituenship in the Stato of Florida that I am Cuing this day is accordance, and in
conformity with Seclioa 222.17. Florida Statutes.
I was formerI a Legal resident of , ~T " ~Jf ---and I
)City) )State)
resided at `~Q~O /~oha,,; STr~P r liowever, I have changed my domicile to
l3tmt and Number)
and am and havo beetf a bona Gde resident of the State of Florida since ~a.t1 Ar ~ Q 94 day of
oZoZ .19~.... and I inside at Sy Ci
(Street and Number)
,tOtT ~'T, .C:IG~/~~ ST. LUG I E County. Florida.
((st~l
and this statcmenl is to be taken as my declaration of citiacnship. actual Icgal residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR ItOMESTEAD PURPOSES,
CHILDREN IN SCHOOI.~ PLEASE STATE PLEASE CHECK:
THEIR NAMES:
ST~~JF.c1 d a _
- - ~.y
z .
43216
rig _ • c~ f=~•i ~ : 35
9~
I FURTIIER CERTIFY that I will register at my local address when Lhe registration books reopen. and comply with all
= other rcquirert:ents of a legal resident of this State.
~ I FURTHER CERTIFY that I have no intention to return tom former domicile. and I intend to remain in
~ T. U C I E -County,
' at,l
Flori a, pcrmancnti; .
~ ~ /
t ~ ~ So~HA
_ ~ -
~ -
Sworn to and su6scribect hefotr, me this day of
_.A.D.19_
ROGER P01'fFtAS. LE:RK OF _C IRCUI T COURT
ST . L UC I E COUNTY, f 1.021 [iA
8Y s O
E P U 1' Y L E R K ~QQx 4~ i':.~t 1
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