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Declaration of ®amic~l~ a ~
X38'753
'I'0 TllE CLENK OFTNE CIRCUITCOURT,
ST. LUC 1 E _ COUNTY. FLORIDA:
This u my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance, and in
conformity with Section 222.IT, F)orida Statutes.
I was tormerl a legal resident of - - y~3 L ~ and I
(Cttrl (State)
resided at ~ ~ ~ . However. I have changed my domicile to
(Stroat sad Numbsrl '
and am and have been a bona fide resident of the State of Florida since ~ ~9 day of
19 - and I reside at
~ _ (Steest sad Number)
~p~ . ,3,3 ST . LUC I E County. Florids,
(pt~l
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
IF.FOR THE PURPOSE Of ENROLLING IF POR HONESTEAO PURPOSESa
' CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK: ~
THEIR NAMES:
' ~ ECOs~DEU
.:G - ..`,~~Tv. Fes:..
4~38'~53
'79 ~~rr 2? PM 2:30
t
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CLr R'rC CihC;;l~ (:i~Ui~'
I FURTHER CERTIFY that I will register at my local address when the registration books reopen. and comply with aU
' other requirements o[ a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain in
z ~ _ ~ ~ ~ i ~ County.
lCit~) -
~';nr;da, permaaenti;.
h...,
' y
~ • • r
• ~ ~
~ - f (Name)
orn to and subscribed before me this ~ day of r
j~Q~ ry9
. A.D.19_ / / ,
~zOGER PO I TRAS. CLERK OF CIRCUIT COURT
~ T. L UG I E COUNTY, F I.OR t UA -
~Y:
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