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Declaration of Domicile and Citizenship
•43.2154
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUC I E COUNTY, FLORIDA:
Thb b my declaration of 0oalieik and Citiseaship is the State of Florida that I am tiuog fhb day is sudana. sad is
eoatormity with Sedioa 222.17. Florida Statutes. .
I Mss former a legal resident of ~ ° ~ I
IClyr) l8at~i
resided at e ,
fg ?Ei - - HoMrover. I bave ehansed aq? domicile to
t8ttwt sad Nuebsd
/1~0 ?~irt ~~P_ ~ sl' dq of 3
and am and have been a boos tide. nesideat or<the State of Fbsida since
?~?ir,13~~P_ ,19~, and beside at O % 9.~ 4.Ief~ _
- ~ r--, teu~..~..arl.~l
~..fi.~ t~ ST.. LUG 1 E County. Florida.
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and tbis statemeat.b to bs taken u aqr declaration of eitiaenship. actual bgal residence sad domiede, in the State of Fbrida.
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IF•FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAO•PURPOSES, -
' CHILDREN ~I N SCHOOt., PLEASE STATE Pt.EASE CHECK:
THEIR NAMES:
FILEO AND RECdRI~E'D$
• ST. t_UCIE COUNTY,'FIA:~ •
N:. ~ORt7 `lERIF1E0
_ - sso
. '79 FE6 6 PNI ~2 : S ~
_ _
CLERK CIRCUIT COURT
I lr'URTHER CERTIFY that I wdl register at my local address when the registration books reopen. sad oomplp with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my tormer~lr. and I intend to remain is
J 7. L V 6 1 L County.
~ taR') .
Fbrida. permaaentl; .
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t
I
~COUNTy •
4 j uFer ^.,~C
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~i Mf :t~:r" -t`
} Sworn to and 3u~seribed before me this ~ day of ' ~ C ~ T
E
- - . A.D.19_ ~ -
ROGER P01 TRAS,,, CLERK Of CIRCUIT COURT
ST. LUGIE COUNTY, FLORIDA
~Y:
EPUTY. LERK
~ooK302 ~~2593
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4. ACO Form 91.71
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