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a~ E~~m~C~ie and Grtiz~n~f._._ }
468859
TO THE CLERK OF THE CIItCU1T OOURT,
ST. L UG I E ~pU~y, FZ.ORIDA:
This is my declaration of I?omicde and Citisenship in the State of Florida that I am iRing this day m accordance, and in
oontorwity with Section 222.17. Florida Statutes. ~
I was former a legal resident of f'f ~ /1~~ L• L~ L 1~. ~ ~/QLc ~8~ ~ and I
lC&7I IStatd
resided at 1~ a 9 L ~Nift S"~ Ho/(Irp t ~•,~Z, g(~ ~ However. I have changed my domicile to
18trMt aaa rr®er~
and am and have been a bona fide resident ottee State of Fbrida since ~ day opt
V ,19~ and I reside at ? 7 /~/4Tl'/1f L/~iS/E }
pO~T ST. L1)C I E ST. LUC I Es~..caaaN~)
County, Florida.
lat~?
f
and this statement is to be taken as my decLration of atirenship. actual legal residence and domicDe in the State aI Florida.
t~
IF fOR THE PURPOSE OF ENROLLING If FOR HOMESTEAD PURPOSES, !
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS j
THEIR NAMES:
FILEU Ah
REr.~,:
OEC 10 8 4s j~'~9
46~t859
I FURTHER CERTIFY that I w~71 register at my local address when the rcgistntion books reopen, and comply with all
other requirements of a kgal•resident of this State.
I FURTIiER CERTIFY that I have no intention to retnrn tom former donaieile. and I intend to remain in
U C E County, .
ICat~l
i
Florida, permanenti;.
j;.c.:atitt~j~~
L;, Vii,' ~ .f1.:..
C. , • r (Naas.)
?urd ' ~ ~ before me this +
. nay of ~J¢'T S7~ L !JL' l ~ ~L/¢. 33~SZ. .
A.D.19_
R G 1 A C ERK OF IRCUI T COURT
ST. LUGIE COUNTY, ftORtO
EPUTY LERK
~o~x321 P~~2922
}