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Declaration of Domicil~ and Citia~nship ~
~ - 43..~646 ~
TO TlIE CLE1tK OF THE CIRCUIT COURT. '
ST. LUC I E CpUNTy~ F1,pRIDA:
This b my deelaration ot Domieile and Citisenshjp In ths Stats ot Florida tbat I un i~ing this day in saordanee, and in
conformily ~ritA Section 222.17. Florida Slatutes.
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1 was formerlY a legal resident ot j-- ~~~~~`~~C ~ , ~D~.-'/!~A and I
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resided ~t ~y~}~ S w• S~ - Ho~rever. I have ebanged my domicile to
(Stre~t aad NumAee! ~ .
and am and have been a boaa Cde resident oi the State ot Florida since d4Y ~
~ Ti9 tl /9~ ,19_~~- and I reside at 8~9 .~?A~2fLO~E~ Al/~l11 ~ _
• ~ l3tr«t aud Numb~)
1nO~T ~LCIC~~ ~ ST. LUG I E County.Ftorida.
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and this statemeat is to be taken as my decLration of citizea~hip. adud legal naidenee and domiu'le in the State oi Florid~.
IF.iOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAO PURPOSES~
' CHIIDREN IN SCHOOL~ PIEASE STATE . PLEA3E CHECK: ~
THE{R NAMES:
r tLEO AND RECOROED~~
• . ~~T. LUCtE C~UNTY. Fl.A.
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43..q646
'79 APP, ~ pN ~2 ~ 23
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' CLERK CIRC~oT :,OJRT
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i I FURTHER CERT7FY that 1 w~71 register at my local address when the ngistration books reopen, and eomply nith all
~~,thcr requiremeats o[ s kgal resident ot this State.
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~ ~ I FURTHER CERTIFY thst I have no iRtrntion to return to m former domieile, and I intend to remain in
~ . U C I E _ County.
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f'~urida, permanenti;.
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~ Sµ~orn to iod subscribed beforo me this ~ day of ~~l'` •.~uC~~Er /CL /f ~
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~ - A.D.19_ ~9
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A Rc~GER P01 TRAS. CLERK OF C IRCUI T COl~2T
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• EPUTY IERK
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