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cclaratiar~ ~ami~ile~ a~~~ ~i~ensi~i~? ~
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4418590
TO THE CLERK OF THE CIRCUIT COURT.
ST . L UC 1 E COUNTY, FLORIDA:
This is uU declaration of Domicile and Citiseaahip in the State of Florida that I am Sling this dq in accordance, and in
conforeuty with 5ectioo 222.17, Florida Statutes.
.
I was former a kgal resident of 1 ~ ~ Juli~(i(,(J ` ~ _ ~C.~t/~/12tL and I
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resided at 3/-~ . However. I have changed my domicile to
18tr+st asd Nos~r)
and am and have been a bona fide naident of the State at F'brida since t day ~
9~ and I reside at "
(8t~wt
ST . LUCIE ~„IIty, Via,
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and this s4tement is to be taken as my declaration of titisenship. actual kgal residence and domicile in the State a[ Florida.
IF FOR THE PURPOSE OP ENROLLING IF FOR HOMESTEAD PURPOSES, i
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
- LEp ANr kt,J.~EO i
~~.LUCIE''siy 'FLA.
aaGE~ .=•s
` ltECOk^ ~E' t t
- poc 6 2 24 PM `19
4;8590
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I F~TRZ'HER CERTIFY that I will register at my Local address when the registration books reopen, and comply with all
~ other requirements of a kgal resident of this State.
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f I FURTHER CERTIFY that I_ have no intention to return to my former domic>7e. and I intend to remain in
U C 1 E' County.
I IRty)
Florida. permanenti; .
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couHry ~~7 ~ 7 -
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~ Sworn ~ ~ before me this ~ day of
.P_ C t M ~ R . A.D.19_ ~ 9 1. RUTS{ ~ . ~.Q Q- 'e
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- ROGER P01 TRAS. CLERK OF CIRCUIT COURT
ST. LUCIE COUNTY, fLOR1UA
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EPUTY LERK -
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