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Deciaration of Domic~le and C~tize s p
4:35950
TO THE CLERK OF THE CIRCUIT COURT.
ST. Ll1C 1 E CpiJPITY~ FI.ORIDA:
This is my deelaratioo of Domicile aad Citiaenship iu the StsLe ot Florida that I am filing this day in accordanoe. and ia
con(ormity with Section 712.17. Florida Statutes. '
I wss to rl a legal resident ot J A C K S O N~ N. H. ~ I
~car~ ~s~au1
resided at M i ~ o~ E MT . TR A 1 L . However. I have changed my domic~e to
IStreat aad I~lumb~r)
and am snd have bcen a bona fide resident ot tAe Stste oi Florida since 1 S T day ui
NOVEMBER ~19 78 .andIresidest OCEAN VILLAGE #C-631 -
2400 SOUTH OCEAN DRIYE~ FT. PIERCE ST. LUGIE~~N~~
Count~, Florida. ;
1(X171 - ~
and this statement is to be talcen as my declaration of citizen~hip. actual legal residence and domic~7e ia the Stste oi Florida.
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IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAO PURPOSES~ ~
CHILDREN IN SCHOOL~ PLEASE STATE PLEASE CHECKt ~ '
THEIR NANES2
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TH I S DCM I G I LE 1 S F 1 LED FOR THE EXPRESS PUR POSE OF CORR ECT 1 NG
THE DATE OF RES I DENCE, 'rJH 1 GH :~JAS I NADVERTENTLY L I STED AS
1977 'v1NEN IT SHOULD 4AVE STATED THE DATE OF ARRIVAI AS 1978, j
~OM~CILES RECORDED IN 0• R. BK. 303 PA6f. 2907 AND 1499.
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~ I FURTHEft CERTIFY thst I w~l register at my local address when the registration booka reopen. and comply with all
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~ other requ'srements of a legal resideat ot this State.
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~ I FURTHER CERTIFY thst I have no intrntion to return to my former domicile. and I intend to remain in -
~ ..r ~ . ~ : . . County.
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Florida, permanenr.i;.
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N'. _ ` - ' ' , ~ ' _ ,
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~ . , FRE~ERiC .J. IBERT~ .JR.
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- HELEN S. AL~~~T
° (Addresd
y Sworn to and subscnbed before me this ~ daq of g~,(~---
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_ , ^:U':TY. F! ;
~ nl'vL . A.D.19_ / / - - _ - ~ . - _ .
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~ ROGER P01 TRAS, CLERK OF C IRCUI T COl~2T 4~95~
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ST. LUC I E COUNTY, FLOR i OA +~9 ?~1~ 1!• 58
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BY.
- EPUTY LERK ~E ~
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= go~~ 3U4 4A~F 972
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