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Declaration of Domicile and Citiienship
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG I E OOUI~I'1'Y. FLORIDA:
This i; mIr declaration of Domicne and~(Stiseaship ie the State of Florida tbat I aw ~ this day ie accordance. and is
conformity with section 222x7. Florida Statutes.
I wax formerly a legal resident odt 'f" ~ ~ E ` 0 ~ T l t ~ T and I
ll71V1 18tatsi
resided at ~ (d ~ l/ Q -However. I have ebanged ~qy domidle to
(&nst sal NssMrl
and am and have been a bona fide resident of the state of Florida since ~ C ~ day of
~ ~r ~cl?'~ee 3ia1~ ~tearr ~r'1(gae zyoa S Ocean. ~1~.
.15~. and I reside at
lStrsst aad NasDar)
F~t e~ e? ST. LUG 1 E
Ictbt County. Florida.
and this statement is to be taken as nq? declaration ai citizenship. sctual legal residence and domicile in the State of Florida.
If FOR THE PURPOSE OP ENROll1NG li FOR HOMESTEAD PURPOSES,
CHII.OREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
~'!_w0 AFlD RECORDED
. ~'.-_.~CtE :.AUNTY, FLA.
~ _~iF-~FE~
434181
'l9 FE6 1'S AM i i : 36
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CLERK ~i^r:~'^' vvi;'
I FURTHER CERTIFY that I wDl register at my local address when the registration boob reopen, and comply with aD
other requirement of a legal naident o[ this State. _
I FURTIiER CERTIFY that I have ao iateatioo to return to formei domicile. and I intend to remain in
i ~ T. L U C I E ~ County.
((5ty)
Florida. permaaentl; . .
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Sworn to and subscn'bed before me this ~ day of J~.LP~L T 33 S~ ~
- ~ A.D.19_ ~9
ROGER POITRAS. CLERK OF CIRCUIT COURT _
ST. LUG I E COUNTY, f LOR 1 OA
EPUTY LERK f
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