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~eclai~ai~on of ~o~~ic~te and Cif«~nsl~ip ~
. 513502 ~
TO THE CLERK OF THE CIRCUIT COURT.
ST . L UG I E ~pUNry. ~1,pRIDA; '
This is my deelaration oi Domic~e and Citizeaship in the State of F7orida that I am Sling this da~ in accordanoe. and in
COAfOI~lL7 R'IL~I SCCt1011 `L`LZ.19. Florida Statutes. ~ .
I v-as formerlq a legal resident of ~~s ~L~~x _ G~• and I
~ lCit7) lStat~)
resided at _._/•Z ~~1~ T~ R~~~N~ ~ . However. I bave cbanged my domic~e Lo
IStrret aad Namber)
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nnd am and have beea a bona fide resident oi tbe State of Florida since ~ ~G - day af
,~~'~'E/y~~'R 19~'~., and I reside at ~~ 70? RS. ~~ j?/~XFOF~ C OG/~'
(Street aad Number)
P~f/1'/ S7 iC !/G/ E' _ ST. LUC 1 E Count~. Florida.
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and this statement is to be taken as my declaratioa of citizenship. artual legal residence and domicle in the State oi Florida.
" IF FOR THE PURPOSE OF ENROLLING IP FOR HOHESTEAD PURPOSES~ -
CHIIDREN IN SCHOOL~ PLEASE STATE PLEASE CHECK: ~
THEIR NAMES:
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p NW ~ii~il ' 4 ~ ~ ~ ~
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C4EkK GIRC~K. ~G~~, /~
:~~g-•~•::t:it'.. --'~/Q~~ -- -
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I FITRTHEA CERT'IFY that I w~11 registxs at my local address when the registratiun boolcs reopen. and comply witb all
o:her requirements oi a legal resident oi th~s State. .
I FtJRTHER CERTff'Y that I have no intention to return to mv former domie~e. and I intend to remnin in
_- 5 T* L U C 1 E , Count~.
ICe.~) _
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F'lorida. permanenti~.
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Sworn ~lb and ~b ~~cn'bed befon me this /~ da~ a~
~ ~-~'" .~._ / 98/
ER POITRAS* CLERK OF GIRCUIT ~Otfi2T
ST. LUGIE COUNTY, FLORi A •
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BY: ~ .
EPUTY I.LERK
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idj 7~ s ,N`~vri~k xF~~'
(Addr'est)
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