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Declaration of Domicile and Citizenship
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TO THE CLERK OF THE CIRCUIT COURT. f
ST. LUG I E COUNTY. FLORIDA:
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This is my deelaration-ot Domic~7e and Citisenship in the Scat. of Florida flat I am Sling this ds)r in accordance. and in F
conformity vritb section 222.19, Florida Statutes. -
I was i rme a legal resident d - ~e_~._~ ~ and I i
I • ICIVI l8tatsa i i
rem at . However. I have changed my domicile to
(Strnst sail NnsOKI
and am and have been a born fide resident otthe State of Florida since ~ d~ ~ i
_.19~ and I reside at ~ • ~ ~i~ ~ ~ ~1 / f
lSef+st sus Numbsrl
~ ST. LUG I E ~ty,~,,
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and this statement is to be taken as my declaration of eitiunship, actual legal nsidenee and domicile in the State of Florida. - {
If fOR THE PURPOSE-Of ENROLLING If FOR HOMESTEAD PURPOSES,
CHIt.DREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES: ;
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I+iLED ,SND R~CORDEO~
ST.:.UC1E rp NTY. FLA.
.-E~;r ~Li
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_ '79 EE6 26 PM f : 4q - - {
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CLERK CIRCUIT %OUR
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I FURTHER CERTIFY that I wRl register at my local address when the registration books reopen, and compb with all
other requirements of a legal resident of this State. -
I FtJ~.THER CERTIFY that I have ao intention to return to my termer domicile. and I intend to remain in
- ST. LUCIE
,County.
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Florida. permanently. - _ - ~ '
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` (Address)
Sworn to and subsrn'bed before me this ~ day of C , -
~3~5~-
ROGER P01 TRAS. CLERK OF CIRCUIT COURT F
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ST. LUGIE COUNTY, FLORiOA ~ .
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_ EPUTY LERK ppcc+~r
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