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pectarafiion of Domicile and Citizenship ~~
. .
S~ 1.892
TO THE CI.ERK OF THE CIRCUIT OOURT.
ST. LUG 1 E ppUN'ry. I~-t,pxIDA;
1'his b m~ deelaration oi Domicile and Gytizenship in t6e State of Florida that I ua filing this d~ in aocardanoe. ar~d i~
contormit,~ writ6 Scction 7.Z2.17. F7orida Statutes. ~ ~
I vPas formerl~ a legal resedent of ~~~~~ n:~~~~ ~~ G- s ~ - ~ i
1~t~1 lStaW
resided at Z•` 1 h L.~ ! i r e 1 . However. t bave cbanged m~ domiale b
(Street aod Nmnb~
and un and have been a bona Sde resident of the. S4ie of Florida sina J.~ n;:: r v 6? 1"' 75 dq aI
,19 and I reside at 11 f~ ;''r oc t o r Lan e
(8trset aod Nnmb~
~,o~ ~ st ,. T_T:~~ e _ ST. LUG 1 E co~cy, ~ria~.
~abt
and this atatement is tfl be taken as m~ declaration oi ritizensbip. actud kgal resi~enee and domicile in tbe State ai Florids.
" IF FOR THE PURPOSE OF ENROLLIN6
CHIIDREN IN SCHOOL~ PLEASE STATE
THEIR NAMES:
~ ' Stac~~ 5cott
r-
- .~
5~ 1_892
I FURTHF.R~ CER'PIF'Y tbat I wiD register at my local addnss when the rrgistration books seopen. and eompl~ with all
ott-er reguiremenb ot : kgal=rsidenl oi thii State.
I Ftl~t~ CERTIl~'Y th~t I have ao intcntion to retnsa to mj formes domie~e. and I intend to remain in ,
-- ~ S T* L U G 1 E , Count7.
lait~) .
IP fOR HOMESTEAD PURPOSES~
PLEASE CHECK: ~
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ROGER P01 TRAS~ CLERK OF G IRCUI T COC~ZT
ST. LUCIE COUNTY, FLORIOA •
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BY: ,~. ~~
(!~ ;/ . EPUTY [.~ERK
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