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Declaration of Dom~c~le and Citizenship ~ .
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TO THE CLERK OF THE CIRCUIT COURT,
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ST. LUG 1 E - --COVI+rrY, FLORIDA: ?
This V tqy declaration of Domicils and Citiseasbip ~ the State o! Florida that I am Ring tbL day io aeeordanos. and in
conformity with Seetion 222.17. Florida Statutes.
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~A-GKs opt/ _ 1Y ~ d 85~ ~ and I
I was f rmer a legal resident of i~
_ ICityt -
resided at ~f ~ p L G ~ T ~ L - _ However. I have changed aqy domidle b
and am and have been a bona fide resident of the State of Fbrida since ~T ~ at
0 GE,iti~ / w E - / t
0 ~ E/Q -19~ and I reside at Z AGO Se OC Ei}~~1 IiF
p (gtrNt and Nnob~e) ~ j
r / C l t - ST . I. UC I E County. Florida. ' '
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and this statement is to be taken as my declaration of dtiunship, actual legal residence and domiede in the State of Florida.
if-FOR THE PURPOSE Of ENROLLING If FOR HOMESTEAD PURPOSES,
CN1t.OREN 1N SCHOOL, 'PLEASE STATE PLEASE CHECK:
-THEIR NAMES: 1+
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79
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I FURTHER CERTIFY that I vrt11 register at my local address when the registration books reopen. and comply with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return tom former domie~7e. and I intend to remain in - }
T. U C I E -County.
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Florida. permaaentl~ . - - '
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G da of z O S o. .r/
Sworn to and subsen'bed before me this y
ROGER P01 TRAS, CLERK OF G IRGUI T COURT
ST. LUG 1 E COUNTY, f FOR 1 DA -
~ BY:
EPUTY IERK
- ~ool<3U3 ~E2~? .
Af;O Form 71 ?2 ~
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