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49458
TO THE CLERK OF THE CIRCUIT COURT.
ST . L UG I E COUNTY, FLORIDA:
This is my declaration of Domicile and Citisenship in the State of Fbrida that I am Sling this dy in acoordanoe. and in
conformity with Section 222.17, Florida Statutes.
- ~,~1~ . '~i` o . 7`' ~ G L~ and I
I was formerl9 alegalresident of
• II~t71 l8tata) i
resided at ~ -Z ~ ~ ~ l(,~ ~ G,~¢+l ~ _ However. I have ebanged domiei7e to
lStreat and Noabarl - i
and am and have been a bona fide resident os the State-ot Fbrida sins ~a day of
.19~ and I reside at f~~/~S ,L,QR, ~
lStrrat aad Nmnb~r)
~i~ r'1`' t f f~.~t c ~ o ~~Q _ - ST. LUG I E County. Florida. .
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domics7e in the State a[ Florida. ,
I
IF FOR THE PURPOSE OF ENROLl1N6 IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK: ~ ~
THEIR MANES:
fx EO AM'.. ~ ~ ~~EO
fT. LUCIE ~ CIA.
ROL-- '!S
RECORr • .
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~ I FURTHER CERTII''Y that I wr71 register at my foal address when the registration books reopen, and comply with all r
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention io return to my former domicile. and I intend to remain in
J 7 .~i. v c. ~ c County.
v 1(:ayl
Florida. permanents; .
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C~;r{~'-t~~,~ ~ 111
~ /•F-ti.... - ~ - (Name) ~
~ sworn to area anbsm"bed before me this ~ aa, of -6~~~ ~ ~ ~ ~.1-~
- ~~eceM bcR _A.D.19_ 79 (~8eve~l ~ ~ BRA
y yJ .
a ROGER P01 TRAS, CLERK OF G IRGUI T GOl~2T ~ 9~a S. ~ • /~R% ES La-rve -
ST. LUGIE GOUNTY, FLORIDA
BY: ~ ~ _ T
EPUTY LERK
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n22 PAGE 402 r . I