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D~clara~ion of Dor~ticil~ aid ~itii~~~t5~~i~
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TO THE CLERK OF THE CIRCUITCOURT. -
ST, LUG I E COUNTY. FLORIDA:
Ibis is mT dee4ntion d Domicile and Citiunahip in the State of Florida that I am filing this daT is accordance. and in
conformity with Section 222.17. Fbrida Statutes.
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I was former a legal resident d
i(1V 19taW
resided at ~ ~ ~ ~ % /~Lc' "However. I bays changed ma domiea7e to
$tieat and Numbrl
and am and have been a bona fide reaidenL d the State d Florida since r ~~~~Q~~ ~ ~ daT d
.19- - and I reside at
nJ tStrMt Nnmb~el
. s~.LJ~_ ~ ;P ~ ST. LUG I E Count, Florida.
. tas~ -
aad this statement is to be taken as m7 declaration d dtizenship, actual legal residence and domia7e in the State d Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN LN SCHOOL., PLEASE STATE Pt.EASE CHECK:
THELR NAMES:
- 19:0 MAR -3 Pil i2~ 07
- FILE(.' ABC ~ ~ ~~:HUt t'
ST.LUCIE CCUNTY.it A.
ROGcR PO1TR.15
CLERK CIRCUIT COt!!tT(////~~
Ewa
Q / 1 v)~
I FURTHER CERTIFY that I w~ register at mT local address when the registration books reopen, and eompb with all
other requirements d a legal resided d this State.
I FURTHER CERTIFY that I have no intention to return to m~ former domicH_e, and I intend to remain in
ST . L UC l E . Conntj.
- «i? . _
Florida, pera?anenti,,•.
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~ -
- - ~ ~ ~ -
Sworn t0 null `
•ei }t?ed before me this - -
ROGER POI TRAS. CLERK Of- G IRGUI T COCEFtT
ST. LUG i E COUNTY, f LOR 1 OA -
BY:
EPUTY <.ERK ~ -
- •
OR
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