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®eclarat~on of Domicile and C~t~zenship
-4'715n8 -
TO THE CLERK OF THE CDtCUIT COURT.
ST. LUG l E COUNTY. FLORIDA:
This is ~ declaration oaf Domic~7e and Citizenship in the State of Florida that I am Sling this dq in accordance. and in
conformity with Section 222.17. Fbrida Statutes. a /
I was fob a legal resident of ~'~~~1`t 6A~? "NE1N Y~1Z~ and I
(CK~I 19tatel
resided at ~ ~,tT
<YI~ C I L~~~ - However. I have changed nq? domicile to
(8a..t acct rtoeae.d .~:h
and am and have been a bona Sde resident of the State of Florida since Z y day of
I~FGeMt3EtZ ,ls
~.~.analresiaeat i~$1 P~- 5~- Lvti~ aLv~.
(8tewt acct NamDKI
~D ; ~~c;i ~ ~ ST . LUC 1 E County. Florida.
ccxcyl
and this statement is to be taken as ~ declaration of dtisenship. actual legal residenea and domicile in the State at Florida.
IF POR THE PURPOSE OF ENROLLING If1~OR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL,. PLEASE STATE PLEASE CHECK: I~-~
THEIR NAMESS
1980 JAN -4 A~1 ~ 30
.f~~El
C POITR SA.
is rsartuT d01~T ~
1l~Itb YERIFlE
4'715118
I F'LTR'1'HER CER13F'Y that I w~71 register at my local address when the registntian books reopen. and comply with all
other requirements of a legal resident of this State.
~ I F[JRTHER CERTIFY that I have no intention to return tom former domicile. and I intend to remain in
_ U C 1 E .County, .
I(itrl
Florida. permanenu; .
f - _
t
t
r.
~t,;r~~ _,RQ L 1~+ Sal: t.~iCiE ~Vt~ t~-~. Stl...r~Z
(Adde.M)
Sworn to and subscn'bed before me this ~ day of
~ANUUR~,/ ,A.n.l$.~_ CGU~/teK 7~aMr~S' ~uTyl~1~~
ROGER P01 TRAS, CLERK OF C IRCUI T C4C~ZT
I ST. LUCIE COUNTY, FLORIDA ~ }
8Y: - i
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EPUTY LERK ~