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Deciar~tion of Domicile and Citia~nshi
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. 43..~i45
TO TItE CLE1tK OF TNE CIRCUIT COURT. ~
. ST. LUC I E (~pUIVTY. FLORIDA:
This b my deelaralion ot Domieile and Citlzen~hip in the State ot F1o~ida lhat I am tiling tbis day ia ~aordance. and ia
contormity witA Section 22Z.17~ Florida Statutea.
1 wu formcrlY a kgal restdent ot ~/Q AD l~ y~ ~ and I
Iqty) lSut~l
res;ded at ' - However. I have c1~aAgcd my domicile to
( aod NumE~r1 . .
and am and have becn a bona Gde resident ot tbe State ot Florida aiace - ~Y ~
' aay~ ~ G~' 9~~L ~ .
19~.. and I reside at
n • ~p , lSteest aod NumbK)
-Y/h~ 4~~ ~'7~l,c.~_c~..~ ST. LUC 1 E County. Florida.
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and this statcment is to be takea as my declaratioa of citizewhip. actual legal reaidence and domicile in tbe State of Florida.
IF.FOR THE PURPOSE OP ENROILiNG IF fOR HOMESTEAO PURPOSES~
' CHILDREN IN SCHOOL~ PIEASE STATE - PIEASE CHECK2 ~
YHEIR NAMESL
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43~..q645
'79 A°R 3 PN ~2 ~ 23
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CLE«K CiRCUtT :.~'JRT.
I FURTHER CERI7FY that I w~l register at my local addnss when the registration books reopen, and comply with all
i o;hcr requiremenb ot a kga! resideat of this State.
~ . I~URTHER CEATIFY that I have no intrntion to return to my former domicile. ~nd I intend to remnin in
i - - - - - - ~ . County.
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~ Flo;ida, permaneati;.
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~ S.~ ern to and subscnbed before me this ~ day of
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~ ~ . A.D.19_ ~9 ~
~ ROGER P01 TRAS, CLERK Of
C IRCUI T COt~2T
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S'T . L UG I E COUNTY, F LOR 1 UA •
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