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Declaration of Domicile and Citizenship ~
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T4 THE CLERK OF THE CIRCUIT COURT.
ST. LUG I E CpUAITy, FI,oRIDA: ~
This is my declaration ot Damicile aad Citisenship in tl~e State oi Fbrida that I am filing this day in accordance, and in ~
ooniormicy wicn Seecion 222.17, E'lorida satuce,.
I wa~ tormerl a kgal resident oi ~ I
~ g y
a~~~ 1(~t7i lStat~)
u A Cc>~ 1 17• . Ho~rever. I have cbang~ed mr domicile w
~ad Naml~1
and am and have beea a boaa Gde rtsident ot the Stale oi Florida since ~ ~y ~
~4'~ r~- ~ j _ 19.~s~. ana i,~staa at I~ o o ~ e a~va t! _~r. -~PT. ~9
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~T ~i ~ r- - ST . l UG I E Count~. ~locida.
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and this state~neat is to be takea a~ mY d~elaration ot citiun~hip. aetual kgal residenee u~d domle~e in the Stst~e of Florida.
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- IF iOR THE PURPOSE Of ENROLLING IF POR HONESTEA~ PURPOSES~ E
CHILOREN IN SCNOOL~ PLEASE STATE PLEASE CNECK! ~
THEIR NAHESS '
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RECORD yERIFIEp
S I ~ Pii'16
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; I FiIRTHER CERTIFY that I will register at my local address when ihe registration books reopen, and eomply with aU
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~ olher requirements of a legal resident of this State. .
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~ I FURTNE~ CERTIFY that I have no intrntion to return ta my former domicile. and I intend to remain in
~ • ~ ST L U C t E ~ County.
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Florida. permanenci; .
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~ Sworn to and subseribed before me this ~ day ot ~v 1 E~ C~ rL~ 33_ y-~~
a ' I, . A.D. l9
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~ r~ M~ Nd I~/ ~t ON~ E
~ ~.'R ~ Rw ~ S CLERK OF CIRCUIT GOURT
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- . ~.ST. ~ Ll~~ .~GOUNTY, FIOR 1 UA
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