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Dec~ar~tion c~f Domicile and G~tizenshi ~
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TO TNE CLERK OF TH~ CIRCUIT COURT.
ST. LUG i E COUNTY. FLORIDA:
This is n~y dcclar~tion of Domicik and Citiaenship in the St~te of Flwida tlu~t I am ~'ding this day in accordance. and in
eon(urmity with Section 222.1?. Florida Stntutes. -
I wu formerlr a lebal resident ot ~ 1• ~ 4~• and 1 ;
~ [,/O(/ S I~LT~~(~ ~'j'~,j S~c~ir~ ~si,k~ ~
reside~ at / / ~ ~L~' ~ . Ilowever, I hnve changed rny domicile to ;
lStteet and Numbc~l ~
aad am and vc becn a bonr Gdc residenl ot the Stete o[ Florida since 2' _ day of f
J u ' I~~ c~ -
C .19~.g.~ aad I residc at ~
(Stteet 4nd NumDer) ~
~O?~~ ~~U~~~ ~ ST. LUG I E County. Florida. ~
(Cit~? ~
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and this statement is tu be taken Rs my declaration ot citizenship. ~ctua) logn! residc:nee and domicile in the State ~t Florida. ~
~F F'OR THE PURPOSC OF E~:ROLLING IF FOR HOMESTCAp PURPOSES~
CHIIDREt~ IN SCHOOL~ PIEASE STATE PLEASE CHECKI ~
THEIR t11.NES: ~
• F~IEU 1!1t~ HECUnJtU
gt. LUC~~ COUNTY f ~A_ .
• ~c 4 i U It CO RS i
, ~ ~,t ;,iFCU . ~
: Y:..~"IE~
i
OCT ~8 IO 39IIH'~~ ~
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I FtJRTHER CERTIFY that I will rc-l;ister at my lucal address whcn the registration books reopen, ~r.d comply ~vith all
oiher req~irements of a lefinl residenl of this State.
F~
1 FURTHE~ CF.[{TIFY that I havc no intc•ntion to rcturn io my [ormer (~JIIlirtlP, and I intend to rcmain i:i
T. U G 1 E . County, '
tCit~l . ~ ~
Florids, permanenti~ . ~ ~
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Sw•orn to and suhserihcd 1,ciorc mc this da ~of
Y f~~7" ST, L~ c u= r~~
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A.D.19. 70 33 y~S 2 '
I
ROGER P011RAS, GLEftK OF C IRCUt T COURT ~
~ ~
ST. IUGiE COUNTY, FlOR1UA ~ ~ :
BY: /~~G„c~~ " ,
, ~rurY ~eRx r A }
- ~ ar;c~c ~~u ~ASE ~ .
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