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461'756
TO THE CLERK OF THE CIRCUIT COURT.
ST. L_UC I E COUNTY, FLORIDw: .
' This is'Eny declaration of I)omict7e and Citizenship in the State of Florida that I am filing this day in aceordsnex. and in
conformity witb Section 222.17. Florida Statutes.
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I was formerl a kgal resident of ISZat.)
1 7 ~
resided at a-~ ~ ~ ~ Sl
/1 •17 • ~ _ However. I have cbanged my domic~7e to ~
(Street N~anDer) ~
and am and have been a bona fide resident of the State of Florida since l da7 of
~~~i2. ,19_L,~L, and I reside at /Y~~~J~iloD ~7 ~ .
(Street and NnmDsr)
~r~ f~ ST. LUG.I E County. Fbrida,
(CYty)
and this statement is to be taken as my declaration of citizeaahip. actual legal residence sad domicile in the State od Fbrida.
IF FOR THE PURPOSE OP ENROLLING Ii FOR HOMESTEAD PURPOSES
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NA'M/ES: - / ~r
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~iilrz ~ f :~79 0~'t -8 P:; i2~ r
E.G~ / V S RaGl:R PO TRASH.
CLEkK ChCUIT CO'
461'7S6
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I~ I FURTHER CERTII''Y that I wt11 register at my local address when the registration books reopen. and comply with aD
~ 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.
icily) _
Florida. permanenti;.
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(Name) ?
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Sworn to and sobsm'bed before me this V day of r f/. G-[lei/ £ .~~Gc - ~3'~ 7S~_
f . A.D.19
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ROGER PO I TRAS. CLERK OF C 1 RGU 1 T GOl~3~„
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ST. LUG 1 E COUNTY, FLOR 1 OA ~ ~ ~ ~ ` .
BY: ~
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