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d Z~iE CLERK OF THE CIRCUIT COURT. ~~s
ST. lUG 1 E COUNTY. FLORIDA: ,
.-Y'his is aty declaration of Domic~e and Citizenship is the State ~of Florida that I am 51ing this day in aecordintx, bad is '
cnnfor~nlty Ritb SecCtoa 2?2.17, Florida Statutes.
M I was formerly a legal resident of ______LF
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z ~-sided at ?1~.! ~ 3 O ~ W - However. I have cbangrd mZ omicIIe to -
tStrsel and Numles) '
and am and have been a bona fide resident of the State of Florida since 17~ day ad
~ l4y -19 r
~
- and I reside st 4 '13 TA ~ oa p n A N r - _
- (Street aadNnmt+es)
PORT ST, b V C i t ST. LUC I E - County, Florida,
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and thas statement is to be ta]cen is my declaration of citizenship; actual legal residence apd domia7e io the State of Florida.
!F FOR THE PURPOSE OF ENROLLING IF iOR HOMESTEAD PURPOS{;S~
CHILDREN {N S[HOOIa PLEASE STATE PLEASE CHECK:
THEIR MANES:
.~iS M. ~ERNoT
-t~ E Ft=n~cy ~ER NcsT -
1919 IlUG 2 I AN ii~ 21
r - S UCI REC~ '
- t>QE~ POTT~T
Ct.ERK CIRCUI
RECQRD VERIFIED
i
I : liii"i'i'_ R C R'FIe'Y that I will register at my ]oc~J address ~chen the registration books reopen, and comply t-.-iih all
r~gvirements of a legal resident of this State.
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I FURTH"R CERTIFY thzt I have ao intrntion to return to m. loaner domicile. and I intend to remain io
_ I T. t_ U C I E -County,
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~ , • ~ r.J ~:a• _r'•_d Lefore me this d`-O~ day of ~ • .
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`=2 Fni: ?~•S,~ CLERK OF CIRCUIT GOUT * ' ,~~z~ ••"""•~~:~.r.t•
? . !_UG 1 E covs~iTY, Fto~ ~ OA ~ ~ • - = -
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