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Declaration of Domicile and Citiz~nship ~
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TO THE CI.EIiK OF THE CIRCUIT COU~tT.
ST. LUC 1 E CpUNTY, FIARIDA: .
This is my decluation of Domlcile and Citiacnship in the Stale ot Fbrids tbat I am filing this day in aeeordance, and in
eoatormity with Section 222.17. Florida Statutes. '
I was tormerlY s kgal resident of 0 /
1 ~ ~ G ~ ~ ~ ~ . • and 1
lCit~1 ISt.u)
resided at c' w G!~ W r~ r . However. l have changed my domicile to
(8t++~t u~d Numb~r) T N
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and am and h~ve been a bons fidc resident of the State of Florid~ aince ~-0"" a day oi
s a~r~•r~~R ip,~ . ;
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- ,19~. and I teside at C N L N o S o ~/1 e v~ 4
(St~t aad Number) }
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1~'T . s% 1 v c ST. Ll1C I E Coun:y, Florida, 7
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and this statement is to be taken as my deelaration of eiliunship. actual legal residence and domicile in the State of F'lorida.
IP FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD Pt3RPO5E5~
CH i LDREN 1 N SCHOOL~ PLEASE STATE PI.EASE CHECKt ~
7HEIR NANES2
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• FILED AM~ RECtlRDEO
\ gT.~JCiL COUMTY FLA•
RG"v=~F;?01TRAS
CIEa~ i i•,C En COURT
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I I FURTHER CERTIFY that I wi11 register at my local address when the registration books reopen, and eomply with aU
; other requirements of a legal resident of this State. `
E I FURTHE~ CERTIFY that I have no intrnlion lo return to my tormer domicile. and I intend to remain in
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~ Fbrida, permanenti, .
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a Sworn to and sabscribed before me this day ot ~~'i -5 i ~ ~ -
~ M lJR_ . A.D. 19 7.~
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ROGER P01 TRAS. CLERK OF C IRCUI T COUF2T
ST. Ll1C I E COUNTY, FLOR 1 UA
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H EPUTY LERK *
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