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432995 ~
TO TLIF: CLI~:ItK OI'' THE CIRCUIT (:OUItT•
i
ST . L UC I E COU1\TI . F[AIi1DA:
This is my declaration of Domicile and Citixonship in t e Slate of Florida that I am tiling this day in accordance. and in
conformity with Section 222.17. Florida Statutes. r ~~Q-tom Cr~,> _
~ ' / ~ and I
I was tormcrl a legal resident of •
lCity) (8tate)
resided at ~-S~ ~ 1-'~ ' z " z~~ ~ o~ - Ilowever• I have changed my domicile to
l3teeat and Numbsr) ~ F
and am and have beoe a bona fide resident of the State of Florida since 3 day of
~
C'' ,~,7Gi-~-G ,19 7~~_ , and I reside at ~ Numbed
~ ~ ~ ST . LUC i E County. Florida,
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and this statement is to be taken as my declaration of citizenship, actual legal reaidenco and domicile is the Stato of Florida.
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IF FOR THE PURPOSE OF ENROLLING. IF FOR~HONESTEAO PURPOSES
CHILDREN IN SCHOOL, PLEASE STATE .PLEASE CHECK:
THEIR NAMES:
• - F11.E0 AND RECOab~~.-: f
_ ~ 1 COUNTY• FI.A:
• ~ ~ . ,,0 32995 .
- _ 4 ~2 ; 32
•~9 ~Eg 5 ~ ~
R~G~_R Pol1i?:.s
. CLERK CIRCUIT CpURT
I FURTHER CERTIFY that I witl register at my lecal address when the registration books reopen. sad comply with all
other requirements of a Icgal resident of this State.
I FURTHE;~ CERTIFY that I have no intention to return tom former domicile, and I intend to remain in
E U C E County.
f ((Scy) -
Fbrida. permanenti; .
f
q~ COUiyT
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Sworn to and subscritred before me this _ ~ day of '~y ~~'3-~
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t i
ROGER POI TRASS~, CLERK OF G IRCUI T GOURT ~
ST. LUG I E COUNTY, FLrOR i.UA
gY;
Ei'UTY LEkK ~p
. SCaI!~~ tO.i:E~ IO ~
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