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Declaration of Domicii~ and Gitia~nshi ~ ~
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TO THE CLEKK OF TNE CIEtCUIT COURT, ~ f
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ST. LUC I E CpUt~T~C~ FLpR1DA: ~
This b my deelaration ot Domicile and Citisenship ia ths State ot Flonda lhat I am filing t1~is day ia aecordance. and in ~
conformity with Sectioa 222.17. ~'lorida Statutes. !
1 was tormerly a kgal reaident ot . ~ I ;
{qtyl ISat~ ;
resided at Ho~rever. I Aave ehaaged my domicile to ~
(St~e~t wd N~uobsr) -
mo
x nd am and 1~ave bcea a bona Cde resident oi the State ot Florida since T~ day of
~S ~ ~ M 13/',~/L ,19 ' ~ aad I reside at ~/.2 . /.Z ~ ~n ,
(Stie~t aad NumbKl
~$~T ~/~~2C'/= ~ ST. LUC I E County.Fbrida,
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and this statement is to be takea a+ my decluation ot eitizenship, actual legal nsidenee and domicile in the State oi Florida. ;
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IF FOR THE PURPOSE OF ENROLLING IF ~OR HOMESTEAO PURPOSES~
' CHIIDREN IN SCHOOL~ PLEASE STATE PLEASE CHFCKS ~
THEIR NAMES:
FIL~O AND_RECOp~QED~
• ~~~Q 7/V'A MM/~ SJ'X %
O ~ Si. LUC1:.. C~UNTY.:fLA:~
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. '79 MA~t 30 PM 1: S ~,p {
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- CLERK CIACU~T COURTt ~
I FURTHER CER1'1FY that I w~11 register at my iocal address ahen the registration books nopea, snd oomply with all
j other requireanents o[ a legal resideat of this Stata.
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~ 1 FURTHE~ CERTIFY that I have no intrntion to return to my former domicile, and I intend W remain in ~
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~ F';orida, permanenti;. s
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` S~~orn to and subscribed before me thia '3 ~ T~ dar of ~~•~'Z"'y rG.
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~ 1"1 ~ 2 `i./ . A.D.19_ 1.1 ¢S7>
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~ F~OGER P01 TRAS,L CLERK OF C IRCUI T COU2T .;.s;- - ~ #
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~ ST. Ll1GIE COUNTY FLORIUA • 'r~~ • . ~
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