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Declaration of Domicile and Citizenship
4'715'70
TO THE CLERK OF THE CIRCUIT COURT. .
ST. LUG i E COUNTY, FLORIDA:
This b to, decLratlon of Domkde and Citizenship in the State of Florida tbat I am filing this day in acoordancs, and in
conformity with Section 222.1T. Florida Statutes. /
I was formes a legal resident of /~s ~ ~ ~ 0 and I
ltw,7~' (StaW
resided at ~p T ~C SomE,e r ~ However. I have changed n~ domiefie to
(8ir~t sad NvsbKl
and am and have been a bona fide resident of the State of Florlda since ~ - dy ~ E
~-~v a ,~3 3 3 ~S~~LT~ ~D
_ 19~ and I reside at
c (8tewt sad Naar)
ST. LUC I E ~h,.a,
(t~bl
and this statement is to be taken as mT declaration of citizenship, setual legal residence and domid7e in the State of Fbrida. -
IF fOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN 1N SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR N NESL
- ,
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i
19~ JAN -4 PN Z~ b7_
~L.tIIGE CO
NiTY A. -
R_
~GERT RAST
- ~t~lllL VER~(EO
4'7~.5'~'O
III'
f I Ft1RTHEB CERTIFY that I wt71 register at my local address when the registration books reopen, and comply with all -
f other regnirements of s legal resident of this State.
j
~ I FiJRTHER CERTIFY that I have no intention to return to my former domicfie. and I intend to remain in
ii U C 1 E _ County.
E 7)
Florida. permanend; . ~ v/-cr1.C.~JL..
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-Sarvii}:..rJ before me this L _ day of
A.D.19~ ~ S b e H N eT ~ g
R G P01 TRAS RK OF C IRCUI f COt~2T .
ST. IE COUNTY, FLORIDA
BY:
' EPUTY LERK
i3o0K~~ PaGE ~7