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- - Declaration of Domicile and Citizenship
TO THE CLERK OF THE CIRCUIT OOURT.
ST. LUC 1 E QOp~y, FIARIDA; 3
4.
This V nq dedaration of Domicile and Citisenship in the State at Florida that I sm S1inS thL dad in aoeordanos. and fa
ooaformitlr with 8eetion 222.17, Florida 8tatutee. -
I was f me a legal resident d - ~~-L
:~'•x~~~ and I
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resided at However. I have changed ray domicils to
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and am and love been a bona Sde resident og the State oiFlorida since - ~ ~
1!~ and I reside at
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ST. LUG I E - tea,
coal
and this statement is to be taken as mJ declaration of dtisenahip. aetwl legal residence and domicile is the State at Florida.
It' iOR THE PURPOSE OF ENROLLING IF fOR HOMESTEAD PURPOSESi
CHILDREN-IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR,NAMES: ) -
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F~tED ANG RECORDED
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- '79 FE8 19 Pa 1:16
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I FURTHER CERTIFY that I will register at ml local address when the registration boob reopen. and oomph with ail
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other eequinments of a legal resident of this State.
I FURTHER CERTIFY that I hive no intention to return to mT former -domicile. and I intend to remain .in
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Florida.~ermanend;. It~l
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's` Sworn to and subscribed before me this r daT d
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{ ~ A.D.19_ ~ /
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ROGER P01 TRAS. CLERK OF C IRGUI T COURT -
ST. LUC I E COUNTY, FI.OR 1 ~A - - -
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E PUTY L.ERK ~ R ~M
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