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TO THE CLERK OF THE CIRCUIT COURT.
ST. LIJC I E COU~Y, ~,Og~A;
' Thin ia~sy decoration of Domic~e and Citizenship in the State of Florida that I am filing this day in accordance. and in
conformity with Section 222.17. Florida Statutes.
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I ryas lormerl a legal resident of L i,~~ .,ZT./ _ /~Y and I ~
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resided at /Scar y /yu s ~•c7 _ However. I have changed my domie~e to
(3trsat and N~onber)
and am and have been a bona fide resident of the State of Florida since -2 _ -day of
_T 19
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- and I reside at .2 ~~~1 L3 T,Src .E~S~.~/ f~iYl.L'
(BtreA.ad Number]
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: ~%i--s4. L G ~ ST . L UG I E County. Florida.
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•nd thi: etatrment u to be taken a_a m~ deelaratien of citizenahin, actual level residence and domia7e in the State of Florida.
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IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NANES:.
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1319 OCT -8 58
fILEO RNU Fcti~r.:2J
ST. Lt1C1E C:L'NTY.ELA.
R06ER POl ~ RA5
CLERK CIFCL'IT Cv~T
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I FURTHER CERTIFY that I wi11 register at my local address when the registration books reopen, and comply with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domic~7e. and I intend to remain in
T. U C I E .County,
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Florida, permanenci;.
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Sworn to~,and subsrnbed before me this ~ day of F/. f'i~= c=_ ~
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i , A.D.19
~ C `Jes eP~? 1U0~-T
ROGER POI TRAS. CLERK OF G IRCUI T COl~2T
ST. LUCI E COUNTY, FLOR 10A _
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