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Declaration o~ Dem~c~le and Citizenship
4ti4344
TO THE CLERK OF THE CTItCU1T COURT.
ST . L UC 1 E COUNTY, FLORIDA: - '
This is m7 detlaration of Domicile and Citisenship in the state of Florida that I am fling this day in aooordanee. and in
conformity : vith Section 222.17. Fbrida,statutes. /
I was formerl a legal naident a~f,.[,~~~~~~~/~"}"'` _ ~ I
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resided st .,~1~~T ~ ~'"~V . However. I have changed eny domicile to
(3tra~t and Nnmbr)
and am and have been a bona fide resident of the State of Florida since day ~
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~~f ,19~. and I reside at ~s~`~~5~ ti•Uio~c'~ 'y~•~
l3tnat aad Nombar) ~
- - ST LUG ! E
• County. Florida.
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and this statement is to be taken as my declaration of dtizensbip. actual legal residence and domic~e in the State of Florida.
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IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES, ~
CHILDREN IN SGHOOLt PLEASE STATE PLEASE CHECKS
T~H~E~IRj NAMESS /
'~19 G~'; 30 2.21 ~
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IILEC RNL Ft~Ui.ut U
S ROGER
PO 7RA5~
CLERK CIRCUIT CBURT
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46.4.344 ~
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I FURTHER CERTIFY that I w~11 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 tom former domicile. and I intend to remain in
U C 1 E County.
Florida. permanenti; .
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Swoe~n to and subsrn'bed before me this O day of _ p p
ROGER PO I'TRAS. CLERK OF C I RCU 1 T COURT, ~
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ST. LUGIE COUNTY, fLOR1OA
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