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Dec,lar~tion of Domicite and Citia~nship .
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TO T~IE CLEltK OF' THE CIRCUIT COURT. '
ST. LUC 1 E CpUNTy, FLORIDA:
Thu i~ my deela~ation of Domicile ~nd Citisenahip in the State ot Florida thaL I am filing this day in accordaace, and in
conformily with Scetion 222.17, Florida Statutes. //1~v1 /~N %
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I wu formerlY a lcgal re~ident oi ~ ^ ~ . r~~L~-~_,~_ and I
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resided at ~ti ~N M ~N~/ f~N ~Q7,~/V , Ho~revor. I have ehaaged my domicile to ~
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and am and have beca a boaa Gde nsident of the State o[Florida since ~ j day oi
~JC ,19~~. and I reside at ~ ~ ~ ea ~~vi~L ~-~Ur ~
~ (stes~t ~od Number)
~D2 / RC°t^ ST. LUG I E County. Florida. ~
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and this statemeat u to be taken as my declaration ot citizenahip. adual legal reaidence ~nd domicile in lhe State oi Florida.
IF.POR THE PURPOSE OF ENROLLIN6 If FOR HOMESTEAD PURPOSES~
' CHILOREN IN SCHOOI.~ PLEASE STATE PLEASE CHECKt ~
THEIR N/1MES2
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~!~L~ ,ECORJED
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I FURTHER CERI7FY that I w11 register at my local address when the registration books nopen, and eomply with all
' other requiremenfs o[ a kgal resident of this State. .
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; . I FURTHER CERTIFY th~ I have no intrntion to return to m former domicile. and I intend to remain in
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E t~'lorida, permaneaLi~. ~
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; S~•orn to and subscribed before me thia ~ 7 day of ~'O~-o~ i~t~ f~1.~L l i~/ ~/jC ~
A pre ~ ~ ~ A.D.19_
ROGER P01 TRAS, CLERK OF C I RCUI T COURT .
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~ ST. LUGIE COUNTY, FLORIUA ~ ~ ~ ~
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