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Declaration of Domicile and Citizenship ~ ~
. . 433'71'7 ' .
TO T}lE CI.ERK OF'1'~iE CIRCUIT COURT.
ST. LUC i E _ ~pUNTY. FIABIDA: _
This_ b my declaration ot Domicile and Citisepship in the State ot Florida that I aca Glins this da~r tu aoeordanee, u~d in
coatormity with Seetion 222.17. Fbrida Statutes.
1 was tonnerl a kgai resident ot i~"'~ ~ Ry~ an~ I
~c~r~ _
resided at S/~;Y ~/~R T/A! d R ('~J[ a AL ~ ! However. I hsve cbunged my docnicile to
(8tnN and Numb~t)
and am and h~ve bee~ a boaa Gde resideat o[ the State ot Fbrida siACe 7~
1~ - and I nside at ~11.~i~ s~ W/f~/T.~1 ~ I~~' ~.U R
- (BtcMt ~sd Nna~M~1
~S ~ ST. LUG 1 E Conne~. F'lorida.
~pt~l ~
and this statcment is to be takea as u~7r decluatioa of citizenship. sctual kgal residenee and domie~e in the Stato oi Fbrid~•
~
IF.F'OR THE PURPOSE Of ENROLLING IP fOR HOMESTEAO PURPOSES~
• CHIL~REN IN SCHOOI~ PLEASE STATE PLEASE CHECKS ~!i '
THEIR NAMES. ~ ~
FlLcC RECORQED'
. ~T ~ r;~~~.TY.r FLA,_
.:.'1~r
. 4:33'71'~
.'Z9 FEB 12 PMI 2: 42
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~ CLERiC~C~R~::'~ '.:v'JRT
I FURT1iER CERTIFY that I w~ill register at my loeal addres3 when the registntioa books reopen. aad eomplr ~?ith all
~ other requircments oi a legal resideat of this State.
! I FURTNER CERTIFY that I have no intention to return to my former domicile. and I intend to remsin ~n
C - U C I E ~ County.
~ . l(St~l
~ Florida. permanenti;.
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& GOUNr`
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V`'~ ~:c., :=r F'-' rS ~ 1~//•// T/I'! D~i ~ D
~ • '~a~.w~~' (Addna)
~ Sworn lo snd ~ubscribed before me tAis ~r day ot ,/Os ~ A ~ ~`~L3 ~
~ A.D.19_ I /
~
~ ROGER P01 TRAS~ CLERK OF C I RGU 1 T COl~2T ~
~ i
~ ST. LUGIE COUNTY, FLORIUA ~
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BY:
EPUTY LERK
• aooK 303 r~cE 431,
. . ~ , . .
~ _ AGO Form 71 7.!
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