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432996 -
TO TI I I: CI.EItf; OF 7'H E CIRCUIT COURT,
ST. LUC I E COVrrrY, FlolunA:
This is my declaration of nomicile and Citizenship in tho State of i''lorida that 1 aM tiling Chia day in accorJance. and in
conformity with Section ~.1T.1•'lorida Statutes. -
I was former! d legal resident of L'~ ~ ~D ~ dfN A and I
y1 (litatel
residrd at ~~pt ADO ~e~••.~.?.? Ilowevor. I have changed my domicile to
sad Number)
and am and have beet) a bona fide resident of the State of Florida since ~•Z day of
ov ey? b¢,Q ,19 78 and I reside at ~ ~'Z QR
(t3treet sad Numbs)
ST. LUG 1 E County. Florida.
(ae~)
and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOHESTEAO Pt1RP.OSrS,
CHILDREN IN SCHOOL, PLEASE STATE - PLEASE .CHECK:
THEIR NAMES:
'KO - FLED Ar1t) RECORDED
.:_l,'C~t COUNTY. FLA.
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'79 FED 5 PM 12:33 oL
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I FURTHER CERTIFY that I wi11 register at my Local address when the registration books reopen. and comply with all _
other requirements of a legal resident of this State.
r
I FURTHER CERTIFY that I have no intention to return tom former domicile. and 1 intend to remain in
~ U C 1 E _ .County.
(City)
E
Florida. permanenti; .
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Sworn to and subscrihed before me this S day of
z
_ _
ROGER POI TRAS,~ CLERK OF CIRCUIT COURT
ST. LUCIE COUNTY, F~ORtUA -
BY:
EPUTY LEt2K ~ I ~a~
9COK ;r
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