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~eciaration of Domicile and C~Y~zensh~p
464451
TO THE CLERK OF THE CIRCUIT COURT.
ST . L uC I E covrlTY, FLORIDA: .
This is my declaration of Domicile and Citizenship in the S4te of Florida that I am filing this day in aoeordance. and in
conformity with Section 222.17. Florida Statutes.
- - I was formerly a legal resident of ~ ~ ~ ~ + E O ~ ~ ~ and I
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resided at ~S 2.. t~~ ]~P/' `J/~- . However. I have changed my domicile to
t3traet and NnmMr)
and am and have been a bona fide resident of the State of Florida since ~o
~ 3 ~ - day of
.19~. and I reside at ~ ~ 3 T
~
~ ~ • C~ ~ U C~
( that and NumDar)
f C ~ ~ S
/ . ~ ~ ~ ST . L UG I E County. Fbrida,
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and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the Sbte opt Florida.
If fOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMESS
~Fn ~ Uc~ ~Gr/~/' pig fin ~
FILED phl~ l ~;:u~..:4
ST.LCCIE CCUNiY.fL:.
F20GER PCITRAS
CLERK Cli?C~'! i CC•LR-~
464451
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply with all
other requirements of a legal resident of this State.
t I FURTHER CERTIFY that I have no intention to returo tom former domicile. and I intend to remain in
f - T. _ U C I E County,
~ 1(~ty) i
~ Florida. permat?enti; . `
j-
- ~ ~ ~ I .
~ i
- ? -
3 ~ t ` (Name)
~~T_~ ~ 1, ~_-y ~ f
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Sworn to and subscn'bed before me this ~ day of ~ G : ~ S~ _ c_ ~ ~T_~~ ~ ~ C~
~(j , A.D.19_ ~1
ROGER POrTRAS. CLERK OF CIRCUIT COURT
ST. LUCIE COUNTY, fLORtOA ~ _
BY: a~ - : ~ ~ v
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E P U T Y L E R K ter -ia , ~ .r