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Declaration of Domic~le and Citiz~nshi~ ~~`-~58
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TO T11E CLEItK OF THE CIRCUIT COURT. '
ST. LUC 1 E ~oUNTy, FI,pR1DA: ~
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This b my declaration ot Domicile and G~liscn~hip in the State of Florida that I am C~ling this day in accordanee. and ia ~
conformity with Section 222.17. Florida Statutes.
I waa formerlY a legal nsideat of ~~'~-~~R-~^~~ , and I
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rresided st / Q' ~ `~~'e e~ - HoMever. I have c6anged mr domicile to
IStee~t ~od Nwo~x) .
an~ am and have beon a bona Cde reaideal of the State oi Florida since day ot '
19~. ~nd I residc~at ~a L~~j v~3 r~sl~-
(8treet ~ad NwnbK)
~ ST. LUC I E Count~r, Florida,
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and this statement is to bs taken a~ mr declaration of citizenahip, utual legal reaidence and domic~e ia the State of Florida.
IF,i'OR THE PURPOSE OF ENROLLING IP FOR HOMESTEAO PURPOSES~
~ CNILDREN IN SCHOOL~ P~EA5E STATE . PLEASE CHECKS ~
THEIR NAMES:
~~o,~ L_eaY, _
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FILEb AND RECORt~E~d~
S;. LL'~tE COUN~~CY. FLA:~ i
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43.q65~i
- '~9 . APR 3 PM I: 43.
;;~1;'tn ~il;Yri:.~
C~ERK CIRCUI7 COUR~
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I FURTHER CERTIFY that I vin'ti register at my local addrw when the registration books reopea, and comply with all
~ c:her requiremeats ot a kgal resident ot this State.
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E. I FURTHER CERTIFY that I have no intxntion to return to m former domicile. and I intend to remsin in
~ . U C 1 E . County.
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~ Flo: ida, permanenti;. :
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~ ~u~orn to and sub~cribed betors me this ~ day oi ~(1 ~ , ~liq .~3 y~ ~
~ ~ _ A.D.19_ . . ~
E ~ 79 . ~
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~ ROGER P01 TRAS, CLERK OF C IRCUI T COl~2T _ ' - . ~
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~ ST. Ll1GIE COUNTY, FLORtUA • •+r' ~
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