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46'7408
TO THE CLERK OF THE CIRCUIT COURT.
ST . L UC I E COUNTY. p-I,pRIDA; .
This is my declaration of Domieiie and Citi:ensbip in the State of Florida that I am filing thin day in accordance. and in
conformity with Section 222.17. Florida Statutes.
I was formerly a legal resident of ~ Gtr and I
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resided at ~ . However. I have changed my domicile to
l8trMt and Nombarl
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and am and have been a bona fide resident of the State of Florida since L~~~ 1~ day of
-19~ and I aside at 0 /y, ~ ~
/ ~ ~~l (9teest aad NnmDar)
d~ ~ S T. L UG I E County, Florida,
ItXtyl
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and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State of Florida.
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IF FOR THE PURPOSE OF ENROLLING IF FOR NOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE ~ PLEASE CHECK:
,
THEIR NAMES: ~
X19 28 ti!4 .1= ~ 2
FIi.fG AN;; -E4~:~:.~; C
ET,LUCiE CGJVTY.fIi..
ROGER POITRt.S
CLERK CIRCI;iI Gl~ :ti'
46'7408
I FL RTHER CERTIFY that I wi11 register at my local address when the registration books reopen. and comply with aU
f
j other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain in -
_ J T. L U C I E ,County.
(City) -
~ Florida, permanenti; .
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~ i c
_
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(Name) j
^ ~ (Addew) .
r Sworn to and subscn-bed before me thin y~ day of
i 9
. A.D.19_
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ROGER P01 TRAS, CLERK OF G IRCUI T GOt~2T .
ST. LUGIE COUNTY, fLORtOA
BY: ~al~~ z
EPUTY LERK
aoi~K321 PEE 194
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