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TO THE CLERK OF THE CIRCUIT COURT,
ST. LUC I E COUh•TT. FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance. and in
rnnformity with Section 222.17. Florida Statutes. t
I was [ormerl a Iegal resident of r ~ ' ~f'~- ; and I
~ ~ „ ~ ,r.'10~71 IStatel
resided at ~ G ~ ~ ~ ~V ~ . However, I have changed my domicile to
IStrcei and Number)
and am and have been a bona fide resident of the Sute of Florida since w i ~ day of
~ _ / G~ ~
.19~, and I reside at ~ ~ l ~ ~ ~ ' ~ ' -'~~1=0'
_ ~ ~ (Street and Number)
~ - f~ ,l~ ~ ~ ? ~/`J ` ST . L UG I E County, Florida,
(Cit7)
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 HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK: ~
THE NAMES: ~ ~ - ~
c c c ~ . ~e c~-~ ~ ~9T9 t~~v 29 P~.i 12: ~:9
'c~`~r ~ '~I' ;w FILEO 1+4L L•)i<;il :i i a
~/"i~-- 1 ~Zc~',r ST.LUCIECCL't;TY.ft~.
ROGER PCiTFi.S
CLEI?j C!f?CUfT C~~ZT
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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.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
_ T. U C I E ,County.
ICit71
Florida, permanents; .
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?c~` ~CUH1Y.4~ (Addreal
Sworn to before me this ~2 day of
~ld?eM ~R A.D.19_ ~ARM~N OWN Pv~
ROGER P01 TRAS, CLERK OF C iRCUi T COI~tT
ST. LUCIE COUNTY, FLORIDA
BY:
EPUTY LERK t
do9K aG1 PACE