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44i'7213
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG I E COUNTY, FLORIDA:
This is my declaration of Domic~7e and Citisenship in the State of Florida that I am 51ing this day in accordance. and in
conformity with Section 222.17. Florida Statutes.
I was formerl a legal resident of ~~`1CK~''Sd % _ ~pS S and I
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resided at .S~ ~ ~
TRW y f V~ . However. I have changed my domicile to
(3cnet and Nmasar) Tit''
and am and have been a bona fide resident of the State of Florida since l/ day of
0~ T .19 ~ ~ . and I reside at a / /~~~1i~GS /17~ ~~l~l~
If3w.c and NmaDerl
~,~T ST, ~ d ~ ST . L UG I E County. Florida.
ICity)
and this statement is to be taken as my declaration of citizenship. sctual legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NANESI ~ `
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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.
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I FURTHER CERTIFY that I have no intxntion to return to my former domicile, and I intend to remain in
, T. U C I E .County.
tCityl
Florida, permanents; .
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S9vorn to and subscribed before me this day of ~~T J T ~y~' ~L' O ~ I - -
A.D.19_ J /
ROGER POI TRAS, CLERK OF CIRCUIT COURT .
ST. LUCIE COUNTY, FL 1 A
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~ EPUTY LERK
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