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Declaration of Domicile and C~tizensh~p ~
435129
TO THE CLERK OF THE CIRCUIT COURT.
t
ST. LUG I E COUNTY. FLORIDA: r'
This la my deslaratfon of Domicils and Citisea:hip is the State of Florida that I sm iRinS this day in aoooTdaaoe. and in
conformity with Seetioa 222.17. Florida Statutes.
I was f a legal resident of ~ sad I
~ - ~y 1 ~
d? 1- However. I have changed my domicils to
resided at ,iC~~~111'2
l9t~e+t sad Nuatb~ .
and am and have been a bona fide resident of the State at Fbrida sinus ~~T.LQ ~ 9 say ~ 1
_ A
ltl___. sad fireside at ~ ~ y ~ • n ~ , e~ ,1,.,=a
(8t~+d dNambtl~-~ ~
~~~C ST. -LUG I E County. i'lorida.
' lave ~ i
and this statement is to be taken as nC?: declaration of dtiunship. actual legal resideaos and domidle In the State of Fbrida.
IF FOR THE PURPOSE OF ENROLLING IF POR HOMESTEAD PURPOSES,
CHiLOREN IN SCHOOL, PLEASE STATE- PLEASE CHECKS
THEIR NAMESS
:
~.L,'~ Cam. ~r~ F +t_ED :.rail F2ECORDEO
435129
• '79 FEB 26 ~M ~ : 31
CLERK ~st:.u'T :.~,:r;
1 FURTIiER CERTIFY that I wi71 register at my local address when the registration books reopen. and comply with all
other requirements of a legal resident of this State. -
4 -
i I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain is
T. U C I E - ,County.
ICic~l - f
` Florida. permanend;.~ -
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i t
° ;
; :
_-i
E Sworn to and subscn'bed before me this ~ day of
9
~2 ~ .A.D.19_
ROGER P0ITRAS, CLERK OF CIRCUIT COURT
- ~ !
ST. LUGiE COUNTY, F1.ORtDA ~ ~
BY:
• EPUTY LERK !1 F Vv~ ,,.:c2615
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A(:0 Fcrm 71 22