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Declaration of Domicile and Citizenship ~
43'7629
TO THE CLEAK OF THE CIItCUTT OOUItT.
ST . L UC I E ~pU~y. ~,p~w: .
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This is mJr decLration oi Domic~7s and GYtiseashIp in tbe StaLe ot Florida t,hat I am 56na this dy in acoordanos. and in
oontormity with Scction 2?2.17. F'lorida Statutes.
I wu fo~zrls s kgal resident ot l/ ~L~~ O ~ and I
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resided at 3~1d w~e r~ P i~-. ~ j~6f/!~ . However. I bave changed mr domieile Lo
18trNt asd Nambr)
sad am aad have been a bona 5de resident of tbe Stst~e of Florida ainoe daJ at
.191 aad I nside at .i~' 37 S C(/ • l:.l~. ~~YY/ ri , f 1/'~~.
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~(1 r~. Sl .~t,c- e[~ ~ ST . L lJG I E Count~. ~'Jw~da,
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and this statement ia to be taken as my decLration of eitiunship. aetual kgal reaidence and domia'le in t6e 8tate of Florida.
If FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAC PURPOSES~
CHILOREN IN SCHOOL~ PLEASE STATE PLEASE CHECKt. ~
THEIR NANES:
C l!_/'~~,~D~~yiJLl/L l
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43~629
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k I FURTHER CERTIFY thst I vm71 register at my local addreas ~vhen the registrstion books reopen, and oumply rvith all
! other requirameats of a kgil nsident of tbis State.
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~ I FURTHER I ve no intention to nturn Lo m former domiu7e. and I intend to remain in
€ _ ~ _ . U C 1 E . CouDty.
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~ Florida. permaneau; . • -
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Sworn to and subxn'bed before me this ~ da~ of r ~ IAddn.~l / ~/I"i
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:i 'n 79 - , ;
. A.D.19_
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~ ROGER P01 TRAS. CLERK OF C I RCU i T COU2T
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~ ST. LUGIE GOUNTY, FLORtOA >
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EPUTY LERK
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