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Declaration of ~ Domicile and Citizenshi
P
4Ei32'~6
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUC 1 E OOU~y, FLORIDA:
This is my decluation of Domicile and Citizenship in the State of Florida flat I am f9ing this dap in accordance. and k
eonformit~ with Section 222.17. Florida Sbtutes.
_
I was formerly a legal resident of _ Q ~ }i ~Q G__ ~o v~ ~ ~iC ~ ~ j. .
(~71 (8tatal
resided at ~~y r
1 Y' l ~ n qr ~ n h /q y ~ . However. I have e6anged my domica7e to
csa..e.a,tN,nse.rl
and am and have been a bona fide resident of the State of Florida since day o f
y h e .19~ and I reside at _ ~ y-5 ~ . 1 y ~/.p ~ l .
(8tewt sad Nambr) i
r f S~- L v c~ ST. LUC 1 E qty,
cave
and this statement is to be taken as my declaration of citisenship. actual legal residence and domicile in the 34te of Florida.
IF fOR THE PURPOSE OF EHROLLIH6 IF fOR HOMESTEAD PURPOSESi
CHILDREN Ik SCHOOLr PLEASE STATE PLEASE CHECK:
THEIR NAMES:
~~~~PY" ~rG -
N ,~rQ nT
Q i r~ E- ! C SIG G~
~i~EU AliO a:Gfik~E U
ST.LUCIE CCUtITY.fLA.
ROGER POI7R.iS
CLERK CfRCUIT CGI;RT
46wi,~ ,
s
t
I FURTHER CERTIFY that I wdl register at my local address when the registration books reopen. and comply with all
other requirements of a legal resident of this State.
i
I FURTHER CERTIFY that I have no intention to return tom former domicile. and I intend to remain in
C E
ICTerI County.
Fkrida, permanenci; . i
~ ,
r
tf;
.l - ~ ~ i
••...,...,~1~
_
Sworn to and snbsasibed before me this day of 'L t.ut. } 3 y~
- . A.D.19_ ~ /
_ _
R~ I AS C ERK OF C IRGUI T COURT
ST. l E COUNTY, FLOR1 A ~ - ,
BY: -
EPUTY I.ERK -
_ ~ - `