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4326133
'1'O Tltr: Cl.l'.RK Ut` TIIF. CIi1CU1T COURT.
ST. LUG I E COUNTY. FLORIDA: ,
This is my declaration of Domicile and Citizenship in the State of Florida that I am tiling this day in accordance, and in
conformity with Section X2.17. Florida St lutes.
~L~G~/ and I
1 was tormerl a legal resident of ~ l~el
icurl
~ However. I have changed my domicile to
resided a
(Street and Nuaeber)
and am and have beeA a bona tide resident of the State of Florida since day of
19_~_,,C.. and I resido at Numbed.
Gl ~ ~ S T . L UG I E County, Florida.
(Cit7)
and this statement is to bo taken as my declaration of citizenship. actual Legal residence and domicile is the State of Florida.
IF fOR THE PURPOSE OP ENROLLING- IF FOR HONESTEAO PURf'OSES~
CHIIOREN iN SCHOOl.~ PLEASE STATE PLEASE CHECK:
THEIR NANES2 ,
• ~ S ~ r FILEO AND RECORO~~_~
LUCIE COUNTY. trLA.:
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'i9 FEB 2 PM 1 ~ 39
Rf ~ I
~
CLERK C1f?CU1Y COURT
I FURTIiFR CERTIFY that I will register at my local address when the registration books reopen, and comply with all
other requirements o[ a legal resident of this State.
I FURTNF,R CERTIFY that I have no intention to return tom former domicile. and I intend to remain in~
U C { E ,County.
iQt~l
Fbrida. permanenti; .
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Sworn to and subscrii~ed betoro me this _ ~ day of ~
i
s . A.D.19_ 7~
s
ROGER POI TRAS,L CLERK OF G IRCi11 T COURT
ST. LUCfE COUNTY, FLO~t1UA
aY:
PUTY _ t,ERY.
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