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Decf~ra~i~~ of Domicile ar~~`: ~.::~~.:;,?~ip
4418033
TO THE CLERK OF THE CIRCUIT COURT. ;
ST. LUG l E -
COUNTY. FLORIDA:
This is my declaration of Domicile and Citisenahip is the State of Fbrida that I am filing this day in accordance. and in
conformity with Section 222.17. Florida Statute{{s~~ t . J
I was formed a legal resident of dJ_ t1 LLc -*A ^ 1 n ~~-U and I 4
/ / (City) IStaN) ;
resided at _ ~ 7 ~~c..~LGG'l.. it ~ - . However. I have elianged my domic7e to
(8t»rt and Numbar!
and am and have been a bona fide resident of the State at Florida since _ ~~r d2 _ day ~ `
19~~. sad I reside at 3 ~ ~ ' J , ~ ~ T!~ /J/l. •
IStse~t and Nmnb~r)
`~S.' ~-~c~.: ST. LUG i E County. Florida,
IQtyl
i
sad this statement is to be taken as my declaration of eitisenship. 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 CHECK2
THEIR NAMESL ~ '
-
r
RILEO ANt~ ~~ItflE
_ - iT. LUCIE : ;:hTY Fl .
RO~EI: ~S
CLERF. GOUA
ItE00R^ rEy~~'f3._Z .
Doc ~1 8 38 AM'7!
468033 •
I FURTHER CERTIFY that I w~71 register at my 1ocaJ address when the registration boob reopen. and comply with aU '
other requirements od 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
U C ! E ~ County.
ICity) _
Florida. permanenu, .
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cilLkiY. F~~Q`O ~ a 1.~1 ~ ~~G~ '
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(Addraaa)
Sworn to and sabeeribed before me this ~ day of
~ A.D.19_
R4S;ER P01 TRAS. CLERK OF C tRCUI T COURT
ST. LUCIE COUNTY, FLORIDA
BY: ~ ~ - j
EPUTY LERK I