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432:791
7b TUE CI,r:RK OF"fllE CIItCt11T COURT.
ST. LUG I E COUNTY. FLOIt1DA: •
This is my declaration of Domicile and Citizonship In the State of Florida that I am thing this day in accordance. and in
conformity .with, Section 22.17. Florida Statutes.
I was farmed a legal resident of _ "a'"'' r^`'~~ r`nnn -and I
1Ck71 1Statel
rnsided at 5Q0 Hi~1 a St . However. I have changed my domicile to
(Street aad Numtrr)
~.,....+..~•w~r 7 ct day of
and am and have been a bona fide resident of the State of Florida since
Nov . - IS...~$_. and I reside at ~ 7 t°nnd--qse . ~ -
_ (8tewt aad Nwaber) .
Ft. Pierce ST. LUC I E Couaty,Florids,
. lGt~1
and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State of Florida.
I F fOR THE PURPOSE OF EMROi.I LNG I F f
OR HONESTEA~ PURPOSES:
CHILDREN IN SCHOOL., PLEASE STATE PLEASE CHECK'
THEIR NAMES.
- FILED ANQ RECORDED -
tiT. L.UCIE COUNTY.° FLa.
43?"J91
' - '19 FE8 2 ~i 1Q ~ 28
. r0''~s? .'4~'TR~~
CLERK CiP.CUIT COURT
I FURTHER CERTIFY that I w~71 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 CERTIFY that I have no into nti_on .to return to m~? former domicile. and I intend to remain in
T. t_ U C I E .County.
f ICityl
Florida. permanemi; .
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L ~ Bernard F Schc~larID
.~t::~~:••...• (Nsrosl
~ 117 pavmond Ave
(Addres.l
Sworn to and subscribed before me this °''J~-- day of ~'t . PieYCe ~ T~ la . 33450
t
r'ebruarY . A.D.19_
ROGER POI TRAS__; CLERK OF G IRGUI T COURT .
ST. LUCIE COUNTY, FLOR UA •
aY:
EPUTY LERK
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