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TO Tl IE CLERK OB' TH C CIRCUIT COURT,
ST. LUC I E COUNTY. FLORIDA:
This is my declaration of Domicile and Citizonship in the State of Florida that I am filing this day In accordance. a~uf-in
conformity with Section ?'.22.17, Florida Statutes..
I was former) a legal resident of * - u 4 ~a"r ~f and 1
ICit7I (state)
resided at ` w ~e'r" w v_w-T , However. l have changed my domicile to
)street aad Iiumbed ~ .L.
and am and have S-eA a bona fide resident of the Stale of Florida since ~ 7 h day of
J~ v? v a~ k ,19~_. and I reside at ? S I s S~ G o w :,T ~ ~ d
(8treet and Nuteberl
f ~ ~'i- u c i e _ ST . L UC I E County. Ftor;da.
tCit~l
and this statement is to be taken as my declaration of citizenship, actual legs) residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, Pt.EASE STATE PLEJISE CHECK:
THEIR MANES : ~---I
• F~LEO ~,ND r~ECDRDED-
L'JC!E COUNTY. FL41. - ~ ,
:rL^ORi YFntr'ED
'T9 FES ~2~ r~ : 22
i:7.%Cfit ~ • ,
CLERK Gr~CJI i CGUR?
I FURTHER CERTIFY chat I wiU register at my local address when the registration books reopen. and comply wish all
other requirements of a legal resident of this State.
I FURTIIE:t CERTIFY that I have no intFntion to return
t~o
m~' former domicile. and I intend to remain in
- ~
; 5 ~ U C 1 E ,County.
lC+cr1
I Fbrida. permanen~l~ . -
fi
-ri. i.
1
. V ~ VV
r Sworn to and subscribed before me this ~ day of
~~T' . A.D.19_
ROGER F'01 ?RAS. CLERK OF- CIRCUIT COURT
~ -
ST. lUC i E COUrJTY, FLOR tUA
I
BYs
e
EPUTY LCRM
d00lI t~C{~~