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46'7151
TO Tl1E CLERK OF THE CIRCUIT COURT.
ST . L UG I E COUNTY. FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am Sling this day in aeeordanoe. and in
conformity with Section 222.17. Florida Statutes. -
I was formerl a legal resident of •7 ` ` ~ U~~~ . ~ ~~~y~ ~ I
(City) (State)
resided at 3/ ~ V/~ ~ ~ . However. I have changed m7 domicile to
(8tr.at and Number) ?
and am and have been a bona fide resident of the State of Florida sines 1+Y 1 ~ T~ day of
~Y .19 ~ L . and I wide at 3~ a p~ ~ U~ ~-V~ .
l8treat aad Nnmberl
.~p)QT ~!/C I E • ST. LUG I E County. Florida.
Idyl - ,
and this statement is to be taken as my declaration of citizenship. actual legal residFnee and domicile In the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMESS ,
C RYST79-~ ~P~9~S6~PoYt 2. ? ~
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ST.tUt:; fOJNTY.F A
- RUGE~ 1'd1YRA
CLERK CittL~tY`CI?~L't~T
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46'7151 ~ '
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I FURTHER CERTIFY that I wt71 register at my local address when the registration hooka reopen. and comply with all ~
' other requirements of a legal resident of this State.
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~ I CERTIFY that I have no lnitntlOn to return tom former domicile. and I intend Lo remain iII
~ U C 1 E ,County, }
(City) ~ ~
E Florida, permanenti; . t
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Sworn to and subsenbed before me this ~ day of
's
~ t
ti 9 ~
_ .A.D.19_ l
3
ROGER PO I TRAS, CLERK OF G I RGUI T COURT
ST. LUGIE COUNTY, FLORtOA
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BY: }
EPUTY LERK t ~ ~ {
80~K PACE ~ 1~'