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Declaration of Domicile and Citizenship .
4'7142
TO THE CLERK OF TAE CIRCUIT COURT.
ST. LUG I E COUNTY, FLORIDw: ~
This is nq declaration oI Domia'ls and Cltlaenship in the state opt >F7orida that I am 8tlag this dad in a~ooordanos. and in
oonioa~mity with Section 222.19. >!7orida Statutes. ^ , /
I was f~ a legal resident o[ u e ~ T _ r' y and I
1(~t71 lBtaW
receded u R ~ l B o b 3/ 6 A _However, I have chaagsd m7 domicile to 3
letnst aad Na~lw
and am and have been a bona bde resident of the state of Florida since ~a ~ ~7 ~
IT U ~ u s T ,19_x. and 1 reside at 3aSn %t/esT lAKe ~R , ve
leteMt..dNas~)
Fo~T P~ e,ec t; ST. LUC I E County, Florida.
IG41
and this statement is to bs taken as ~ dec4ration of citirenship. actual legal residence and domicle in the State a[ Florida. )
l i
IF fOR THE PURPOSE Oi ENROLLING Ilr FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK2 ~j
THEIR NAMES: ~ v ~
• 1 C QRvI D 8 LtlyFaR/~
JAN -3 Ji*! il~ 51
i~N lh~A.
tXERK CNtglIT OOIIRT
R>:COIt9 vERtftEp
- ~ 4'71412
~ I FURTHER CERTIFY that I wi71 register at m7 local address when the ngistntion books reopen, and oomplT with all
other requirements of a legal resident of this Stste.
I FURTHER CERTIFY that I have no intention to return tom former domicile. dad I intend to remain in '
l U C I E County.
1at71
Florida. permanend; .
e
C~ UNl
V ~ ~ :OG
oN, 3as~ li-~s; Lf1Ke OR~ye I
vt~~ •-CUtiTY•FL p IAddnM) ~
~ Sworn to and subscribed before me this 3 day of ~o f~T - f ~ IQC C~-- FL - 33 S O }
e ` ~ r 3
' ~Hnj U a i2~ . A.D.19~- C A R ~ I
q N To R ~l) ~
ROGER P01 TRAS1 CLERK OF C IRCUI T COr~2T j
i
ST. LUCIE COUNTY, FLORiOA
EPUTY LERK
t ,
. - 3~'3 P~ 512