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Declaration of Domicit~ and Citiaenship
• 4:38852 .
TO TILE CLEItK OF THE CIRCUIT COURT. •
_ ST. LUC I E COUNTY, FLORIDA: .
This js my declaration of Domicile snd Citizenship in the State of Florida that I am filing fhb day in accordance. and in
contormily with Section 222.17. Florida Statutes.
I was formerly a legal resident of = ~ ~t~l~~ ~ ~•`S toil and I
resided at ~ 1 u`~S ~ `C. . However. I have ehaaged my domicile to
• lStnK and Numt+sr)
and am and have been a bona tide resident of the State of Florida sines ~ Q day of
_ ~ti~ CX1 ,19~~. and I reside at ~ ~ ~ ~ j a r~ a ~ r
~ (Street aad Numt+srl
~ 1 t ~ p_ _ ST . L UC I E County. Florida.
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and this statement is to be taken as my declaration of citizenship. actual legal residence and domic~7e in the State of Florida.
IF fOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
' CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR1 NAMES:
~o h r~, J~A•r ~\~-e.~~~\c~
_ \ ( ~ EO A;Vt7 RECORDED
~~nWtlc~a t~~l W A,~~~I~Id - COUtvTY.[`(F~LA.
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'79 t~R 28 AM i i : 25
' CLERK Cie?C:~IT CGUR i
I FURTHER CERTIFY that I will register at my Local address when the registration books reopen. and comply with all
I o!her requirements of a Legal resident of this State.
. I FURTHER CERTIFY that I have no intention to return tom former domicile, and I intend to remain in
_ LUG 1 E .County.
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ICit~l
f'iorida. permanen~i;.
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~ _ F~CUkTY. F~~~ 0~
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:k ~ ~ r~~, (Name ~ 3
~ 1 (Addrea)
~ ~titi~orn to and subscribed before me this 4 ~ day of
I
//~~-~lr . A.D.19_ 79
,ROGER PO I TRAS, CLERK OF CIRCUIT COURT ~
ST. LUG I E COUNTY, FL_OR 1 UA
E3Y:
EPUTY LERK
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