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Declaration of Domicile and C~tlzenshlp
. 4~78s24
TO THE CLEAR OF THE CIACtJ1T COURT.
ST. LUC 1 E QOU~Y, P7,0~A;
This I: m~ declaration d Domiclk sad Cltisenshtp In tbs State d Florida that I am f>7ing this dy in aooordanos. and is
wafarrnitF with Section 222.17. Florida Statutes.
I was fonaer a legal resident d and I
. ICi4i (8tatrol
resided at However. I have changed nv doaaidle to
sad
a~ am and have been a bona fide resident d the State Florida since G dalr d
i 1!~ and I reside ~ . ~1~C
18trMt anaNaebed
~ ~ ST . l UC 1 E h7orida.
(cw~ -
and this statement is to be taken as m~ declaration d dtizenship. actual legal residence and domieIk in the $tats d F7oeids.
IF FOR THE PURPOSE Oi ENROItING IF FdR HOMESTEAD PURPOSES,
CHtLOREN jN SCHOOI, PLEASE STATE PLEA~}E CHECKS
THEIR AMESS
~p Nit _T ~ ~ 1
_ .4`78624
I FURTHER CERTIFY that I ~ register at mT local address when the registration boob reopen, sad oomp},y w~h aD
other regniremeMa d a legal resided d this State.
CERTIFY that I have no intentioa to refute to mF former do
~`te. and I Intend to remain in
. ~r . L UC I E ~ ~i,
(~i
Fbrids, permanentt,-.
! ` j:
i ~ .s GAGJ'
~i
'~$l~rae'n to'a~ ab before this ~ da] d
RQGER P'OITRAS. CLERK OF CIRGUI T COtd2T C~cL~.1eS t'
ST. LUCIE COUNTY, fLOR10A
BYs .
EPUTY LERK
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