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Declaration of Domicile and Citizenship ~ ~
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1~0 TAE t~.ERR OFTAE ~ COURT.
S~~. LUC 1 E OOUNTY. F1,pRtpA:.
`,'Tbb is n41 deelaratioa of Daasieik aad Citisenship in the State at Fbrida that I am this dq in acoordana. and is
. _ eoafoemi~j w~ Section 228.17. Florida Statutes. _
.r I was a legal resided e[ and I
tc~cT) t~+sd
resided at - Aawever. I have changed mT domicile to r
18tr«t and Nombael -
and amend Lave been s bona fde resident at the State of Florida sins ~ ~ ~ ~ d
M n ~ . ~ ~ ,19 ~7 ~ - and I reside at l71 ~ I c~rQ s~ `~~:.~p~
18trMe ud N.wb~el -
P~ s~ . Z.>~ .o ~ ST, lUC I E ConotT, Florids.
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and thb stateaoe~ b to be taken a: m,T deelantioo oz eitiunship. actual legal rasidenoe and domie~e is the State a[ Florida.
IF iOR THE PURPOSE~OP ENROLt.iNG IF FOR HOMESTEAD PURPOSES~-
CHILDREN iN SCHOOL, PLEASE STATE PLEASE CHECK: ~ .
THEIR NAMES2
I9t9 AU6 10 PM 2 03
g~~ R ITRA~~
SlEitli CIRCINT C
RECORD VERIFIED
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~ I FtJRT'IIER CERTIFY that I w~ at m local address when the re ' tan books and with aD
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~ other r~egoinments of a legal resident of this State. .
I FIJRTAER CERTII~'Y tbst I have no intention to return to mT former domieAe. and I intend to remain m
C E CoantT.
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Florida, permanend;
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Swoen toand sobsenbedbefore me this ~ daj oir P~ e i 9 .Feet n , 33~5c~
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~.D.~.; 79 - .
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R A C K OF CIRCUIT COURT
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ST. LUCIE COUNTY, FLORiW1 -
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BY: ~
• PUTY LER b
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