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Declaration of Domicile a d. C t e s p
4164
TO THF: CLERK OF THE CII;CUIT COURT,
ST. L UG I E COUNTY. FLORIDA:
This is mT declaration of Domic7e and Citi:eaship in the State of Fbrida that I am fling this dad in aaoordanoe. and in
oonfarmit~ witb Section 222.17. Fbrida Statutes.
I was former a legal resident of ~ -1?u) XLl!' and I
Ittit7) IStatd
resided at rhA _G n n ~ S - However. I have changed ml domic7e to
18traaR and Numbar) ~ ~ ~
and am and have been a bona fide resident of the State of Florida sines l ~7 ~
n
19~.~and I reside at ~ '~~n' ~n ~ » ` ~ 1-
~ ISM and NamDad
ST. LUC 1 E ~ti, Ada,
ICtt7)
and this statement is to be taken sa m~ declaration at citizenship. actual kgai residence and domicle in the State of Florida.
IF FOR THE PURPOSE OP ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMES: ~ i
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i
. 19~01?UG 25 Aft 9~ ~ 5
fILEQ RNC ~EL'UND£D
ST.IUCIf. COUN f Y. f l A.
R06ER f OITRAS
` CLERK CIRCUIT COURT
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nf~^EI!~iFIfIfO-_ ~
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~ I FURTHER CERTIFY that I w9l register at mT local address when the registration books reopen. and eompl~ with all
other regairements of a legal resident of this State.
E I FURTHER CERTIFY that I have no intention to retnrn to mT former domiei7e. and I intend to remain in
f ~ _ JT . LUG _ Count.
c IC~~)
f Florida. permanenu;.
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f ~ . +ti - . . (Addy/sad E
~.voro to Ind}bbi~n`~ before me this ~ dad of
'w ' • ' A.D.1 ~
~ CLERK OF CIRCUIT COt~2T
ST. LUCIE COUNTY, FL 10A
'
E BY: =
EPUTY LERK `
_ ~ ~ ~ -
PItGE
BOOM ~ ~ i -
.