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469435
T~1 THF. CLERK OF THE CIRCUIT (COURT.
ST. LUC I E COUNTY, FLORIDA:
This is my declaration oI Domicile and Citizenship in the State of Florida that I am Slim this dad in socordanoe. and in
rnnforv?ity with Section 222.17. FlOSida Statutes.
I was ion a legal resident of ~ A ~/y ~lr y~~ ~i~v a, and I
.~j I(2ty1 IStw)
resided at T~lJQ/S~~/4wl~ j~.P~ vE , However. I have changed my domicile to f
18traN aad Nvmar)
and am and have been s bona tilde resident of the State o[ Florida ainoe .(y-tc / y 7 ~y ~ ~
19
~
~ and I aside at ~ O 5 S W _ ~,/7woo c~ Q ~ ~ L
18trmt aid Nnmbal
~o Q7 ~T via c , ~ ST. LUG I E County Florida,
ICtty)
and this statement is to be taken as my declaration of citizenship. actual legal residence and domict7e in the State of Florida.
i
IF FOR THE PURPOSE OF ENROLIlNG IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMESS
~£U f a f Qo•i- 132 ~j /4 +
LEO ANt ~ ~ t ~ ~OEp
i1~.LUCtr ~ FtA
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Doc ICI 8 4~ A~ '~19
4f9435
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I FURTHER CERTII~'Y that I wt11 register at my loe~l address when the registntian books reopen. and comply with all
other requirements of a legal resident of this State. '
- I F'[JRTHF.R CERTIFY that I have no intention to return to my former domicile. sod I intend to remain ~ in
UCIE
County.
laity)
Florida. permaneati, .
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Swoi~b~4~~l~ed before me this day of
ROGER R01 TRASH CLERK OF CIRCUIT COURT
ST. LUC 1 E COUNTY, f LOk t DA
EPUTV t.ERK i
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