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n of Domicile and Citizenshi
Deciarat~o p
481196
TO THE CLERK OF THE CIACUTT COURT.
ST . L UC I E OOUNTY, FLORIDA:
This is my declaration of Domicile and Cltiaenship in the State of Florida that I am Sling this dq in accordance. and in
conformity with Section 222.17. Florida Statute~s.~ `A ,
I waa former a legal resident of f 1
E ~t (1 G (~I - "v I I
_ ICit7) ISwa)
resided at ~_!._4 a a- ~ , w E5? ~ 1 ~ 1~ ~ However. I have changed my domicile to
and Nambarl
and am and have been a bona fide resident of the State of Florida since ~I ~ ~ T ~1 ~ ~
j a
O C ~l R_ NETTLE S-~~L~~~
~~N .19~andIresideat ~ N~ ~~QOL/N,s9 .
_ ~ (l3trad aad Nambt)
E N S E E~9 C~ I-1 ST . L UC I E qty, Florida,
ccxgl
and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State at Florida.
-'IF POR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMES:
!MR 28 ~ ~ 38
L ro
r~~.
• * y~
atc:+t+~ vo__~--1--- -
- 481196 .
I FURTHER CERTIFY that I wdI register at my local address when the registration books reopen. and comply with all
other requirements of a legal resident of this State.
~ I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain in -
_ T. ~ ~ a -Canty.
_
((Sayl - -
Florida. permanentl; .
GOUN
-~~.t~+i~• rye _
z ; 3~ ; ~
1 i
tit
sworn to area subseri'bed before me this a g day of ~?~.t5~u. ~ ~ Q 3 34.5
~ ~ ,e.D.is~-- Je RyN A. GARi~h
ROGER POITRAS. CLERK OF CIRCUIT C0~2T ~
ST. LUGIE COUNTY, FLORiOA
BY: ~
EPUTY LERK -
. 6pOK•,aGO PaGE~~
- Ar0 Form 71.E
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