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Deciarai~~~:. _ : _ .-~:.-.~:~~e and C~~~::_~~
?5hip
44',9'71
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUC I E COUNTY, FLORIDA:
This is my declaration of Domicile and Citisenship in the State of Florida that I am filing this day In accordance. and in
conformity with Section 222.17. Florida Statutes.
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I was formed a legal resident of G r e e k ~0 2 T. 'U ~w /D K k and I
ICity1 18tsatd
resided at A? R- i~ ~ Q d ~/~e ~ Der v~. However. l have chatssed ~ domicSe to
18treet and Number)
,V e r . / 5 , t 9, 7 day of
and am and have been a bona Sde resident of the State of Florida since n
A!o v _ (S _ i8- 7 9 - and I reside at ~ 9 7 ~ S(" ~R' ~ r ~ ` C ~ •2
18treet sad Namberl
f
a2T. S ! ~ v c , 'E _ ST. LUG I E qty, Via, '
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and this a4tement is b be taken as my declaration of eitiumhip, actual legal residence and domie~e in the State of Florida. i
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKt I- x~ t
THEIR NAMES: i1 -
FItLED AN: . COED
>1T.lUCtf. v' 'FLA.
CIER~ ~ - :,':CU
RECO~'
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i
~ I FURTHER CERTIFY that I w~71 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 CER1•IE'Y that I have no intention b return tom former domicile. and I intend b remain in
U C 1 E County.
•
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Florida, permanenu; .
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f
f .O~
,r-. ~ ' ~ (Name)
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I if couyrt.F` (Addtw) ~
~ Sworn b and before me this ~ day of ~a ~,tl c'. ! ~
~ A.D.19
~~e"' - 79 ~ ~.a boy T ~os7e~e~
~ - ROGER PO i TRAS, CLERK OF C i RCU I T COURT r/
1` F}-r~i le eiv Q. ~ s7-e~
ST. LUGIE COUNTY, FLORIDA
BY : f~ ~ -
EPUTY LERK -
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[?R PACE
BQOK
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