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. 47045
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TOTHE CLERK OF THE CIRCUIT COURT.
S~•. LUG ! E COUNTY, t-i,ORIDA; "
~ 4'his is !ay decLratioa of Domits7e and Citizenship in the State of Florida that I am filing this day in aecordanoe, and in
conformity witb Sertioa 2?1.17. Florida Statutes. -
' I wss lormer) a kga) resident of YQ r~ t' ~l~i r ~ and I
resided at Aowever. I have changed my domic~7e to
(Sired and Ntaabes) -
and am and have been a bona Sde resident of the State of Florida since ~ day of
. .,19~ and I reside at r ~ ~ .T
~ [9tretrt and Nnmbv)
~o ~ ~ f!i_ ;.JCJ ST . L UG t E County, Florida,
[City1
and this statement is to be taken as my declaration of citizenship, actual legs) residence and domia~e in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES
CHILDREN !N SCNOOLr-PtEASE STATE PLEASE CHECK:
THEIR NAMES:
f `
~ 1
°~9 r~~. 23 P~4 2~ 21
FILt~U F~t~ FELL r.:)~ ti
ST.LUCIE000NiY.FI~.
ROGER PdITRAS
CLERK GRCy17 COURT
4S'7045
I F[TRTHER CERTIFY that I w~71 register at my )ocal address when the registration books reopen, and oomp)y with all
other requirements ai a )egal resident of this State.
I F[IRTAER CERTIFY that I have no intention to return to my former domiu'le. and I intend to remain in '
7. U C I E _ County.
_ ICity3
Florida, permanenti;.
..~„tttrr~~ ' .
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Swarm to and sobstribed before me this day of -
~D.19
~ ~1 .
ROGER t'OITRAS. CLERK OF C tRCUt T CO[~2T ~ ~ .
ST. LUG t E COUNTY, FLOR 1 OA
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