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432843
TO T111•: CLGItK OF Tli~: CIRCUIT COURT.
ST. LUG I E COUNTY. FLORIDA: -
This is my declaration of Domicile and Citizenship in the State of l''lorida that 1 am t7ing this day in accordance. and in
tontormity with Section 7.12.17, Florida Statutes.
I was former) a legal resident of - and 1
tCitrl tstatel
resided at °'~6 ~ ~ . Nowovor, I have changed my domicile to
l8t~ad aad Number) .
and am and have bceA a bona fide resident of the State of Florida since ~ day of
19
7q
- and I reside at 6~
(Street and Numbed .
_ _ _ ST, lUG I E County. Florida,
tCtt~l -
and this statement is to be taken as my declaration of citizenship, actual legal residenw and domicile is the State of Florida.
IF FOR THE PURPOSE. OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLtASC CHECK: - r~
THEIR NAMES: - 1-
• FILED AND REC~lRD~U' •
. ST, t_UCIE COUNTY. }1A.:
- - 432843
'Z9 FE6 2 PM I : 43
- ~
CLERK CIRCUIT COURT
I FURTHER CERTIFY that I will register at my local address when the registration books reopen. end comply with all
other requirements-of a legal resident of this State.
I FURTHER- CERTIFY that I have no .intention to re_turn~to~m~ farmer domicile. and 1 intend to remain in
~S~Tu
C~i
t~ -County,
tGtrl -
E
~ Fbrida, pcrmanenti; .
e
I
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y ~.2~.-.e
a /
C~),E~'~ ~ Addreaa
Sworn 1o an subscribed before me this ~ day of
3 f/S7
# A.D.19_
r
ROGER P01 TRASH G ERK 0~ CIRCUIT COURT
I •
-
ST. LUGIE COUNTY, FLOFt
E3Y:
E U Y LERK U R
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