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Declaration of Domicile and Citizenship / •
4:38352
TO TILE CLE1tK OF THE CIRCUIT COURT. •
ST. LUC I E COUNTY, FLORIDA:
This b my declaration of Domicile and Citizenship in the State of Florida that I am filing this de?y is accordance, and in
conformity with Section 222.17, Florida Statutes.
1 was tormerl a legal resident of ~ - ---~~a~.~0' ~`~'~O`-' a"d I
tqq) IState)
resided at ~Z \~~VW~ ~a"~A-1 - However. I have changed my domicile to
(Steset and Number)
and am and have beon a bona tide resident of the State of Florida since ~ 2- ~ - ~ o day of
. - _ 19 - and I reside at ~SS ~ ~ ~ `y~ S
18treet and Number)
_ ~ g J ~ ST . L UC I E County, Florida,
t(:tt7)
and this statement is to be taken w my declaration of citizenship, actual legal naideace and doa~ieile in the State of Florida.
IF.fOR THE PURPOSE OF ENROLLING IF iOR HOMESTEAD PURPOSESr
CHILDREN tN SCHOOI.s PLEASE STATE PLEASE CHECK:
THEIR NAMES: C
` \ i `~3
~ Y , A~=n RECORDED
~ _ s• t~EDr1E ^~UhTY. Fl.
-438352
,79 Mk"~? 23 PM ~2 : ~ 1
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply with all
ether requirements of a legal resident of this Statt.
. I FURTHER CERTIFY that I have no intention to return to m~ former domicile, and I intend to remain in
z JT
~L u
G~ i^
E ~ ,County.
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tc~ty)
Florida, permaneati;.
x
~i0 Uhf r
J~~r~~«f~~,r o
t • . (Nam.) . , ' _
• ~2 (Addtea)
~w orn to and subscribed before me this o"~ day of 3~c
~S
r , A.D.19_ ~1
F<OGER POI TRAS. CLERK OF C I~RCUI T -COURT
S T. L UG I E COUNTY, F I.OR 1 UA
y
EPUTY LERK
~iU5 1934
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