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~~iaraYEO~~ o~ ~amicile• and Ci~~:~~ ~
468984
TO THE CLERK OF THE CDtCUIT COURT.
ST . L UC t E COUI+ITY. 1'-I,pRIDA:
This is my declaration of Domidle and Citizenship in the Stats of Fbrida flat I am filing this day in accordance. sad in
conformity with Section ?22.17. Florida Statutes. _ •
I was formed' a legal resident of ~4 M~OE~~~ ~ e~ ~ S and I
~ lsut.)
resided at \ ~ ti y \ \ ~ D ~ ~ ~-P ~A~.~ ~ ~ . _ However. I have changed my domiei7e to
18w~t asd NmDwl
and am and have been a bona fide resident of the State of Florida since ~ day of
e C .19~ and I reside at ~ ~ ~ N . W . ~.1Q.NS S~
(StrMt sad Numb.rl
o S~ . ~.~•C ~ ~ ST. LUG 1 E County, Florian.
_ tcst~? .
and this statement is to be taken as my declaration of citizenship. actual legal reaidenee sad domicile in the State of Florida. ~
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK: ~ ~
THEIR NAMES: ~ '
\....•e..a~ e~
F LED 1hi' ~~EO
_ LUCIE _ rlA.
CLERK • ;QI;R
RECCE~• r` ~
- Dec 10 3 20 P~! '1~ ~ .
R
468984
I
j I FURTHER CERTIFY that I wi71 register at my local address when the registration books reopen. sad comply with all ~
other requirements of a legal resident of this State.
~ I FURTHER CERTIFY thst I have no intention to return to my former~~ile. and I intend to remain in
~ _ ~ .TU C I E .County.
ICit~)
Florida. permanence; .
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a ~+~3.W~a~~a 010 iN~~J~`~ ~ J~
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°t Sworn to and subscn"bed before me this ~ ~ day of ~0~~- ~~.t°` ~ - ~ J~ y~ a
4
~ -
Q- . A.D.19_ ~1
~ ROGER POI TRAS. CLERK OF C IRGUI T COURT
t
5
ST. LUCIE COUNTY, FLORIDA
~
BY:
~ EPUTY IERK -
sn~32~ ~E ~i91 ,
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