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TO THE CLERK OF THE CIRCUIT COURT. •
ST. lUC 1 E COUNTY. FLORIDA:
This is my decl~ratio~ ot Domicilc ~nd Citizcnehip i~ lho Sta~to o[ Florida that 1 sm tding thi~ dey in accordancc. end in t
contormity with Section 222.17. Florida Statute~. '
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I was tormcrl~• a legal rc~ident ot ,~l n~~'~ ~ U ~~~L , ~`'I ~ rNi ~iv~ and I
tCit~l lstae.) #
resided at ~v ~NG %
d~? .};owever.l have changed my domicile to
(St+e+t ~nd Num~er) -
and am and have bccn a bona fidc reside~t oI the Stutc of Florida since U f"~ day of ~
~ / ~ / :y % 19
1.,~. and I reside at f ~ y ~i L ~7 C /9
tStreet aad Numberl
/ S' L U C/ t.
! ST-. L lK 1£ County, Ftorida,
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and this statement is to be taken as eny declaration of citizenship. nctual 1ega) residence and domicile in the State ot Floride.
If F'OR THE PURPOSE OF ENROLLING IF FOR HOFtESTEAD PURPOSES~
CHILDREN IN SCHOOL~ PLEASE ST/17E .PLEASE CHECK: ~
THEIR NAMES:
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I FUR•r~~r•.~: CF:}{1'IF]' tl?at 1~ril! r[F;is?cr tt my local addre~s when thc refii;trtion bc?oks reoprn, and cum~~l~• ~vith t+ti
othcr rcqu'ucuicnte o! ~ Ic~;al rc~ident ut thi~ Statc.
l FUILTIII'~{ CI:R7'II,^~' that T 1~:~vc no i~itc•ntinn to mturn to m~• fnrmc: do:nicil~, a~~:3 1 inLcnd to r~niai:: ii, '
~ ~Lj~ / ~ tJG~[ --ST •_-L UC-!-f-- - County, ~
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