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Declaration of Domicile and Citizenship
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TO THE CLERK OF THE CIRCUIT COURT.
ST. lUG 1 E COUNTY. FLORIDA:
TbL L iAl? declaration of Domkile and Citisenship In the State of Florida that I am Sling this dad in accordanos, and in
conformity with Section 222.19. Florida Statutes. -
I was former a legal resident aI ~ y~~C s ~ I ^~"-~4t1--
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ICiy
Sri- ~ rI ]-F t'pA Q . However. I have changed my domid7e to
resided at ~3Q,.~ i,
l8tr•~t aoa NomD'id ~ '
and am and have been a bona 8de resident of the State of Florida since -~G ?'~~~r~ ~ oI ~ ~ "
~F" . i~_~. and 3 reside at / ~ L V ~ n n u .p 7? ~
" ISte«t asd NambFf) }
t,_ r 1~.~ A tE-~ ST . L UG I E CoantY. lF7orlda. `
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and this statement is to be t#ken •s declaratioa d dtir~enship, actusl legal reaidenee and domicile in tbs State aI Fbrids. ~ ~
IF FOR THE PURPOSE OP ENROLLING IF FOR HOMESTEAD PURPOSESa ~
CHILDREN IN SCHOOLS PLEASE STATE PLEASE CHECKt
THEIR NAMESS
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"bNp RECOftD~D'
~~.~--~---~~i'~ _ ~1tE~C~E COUNTY. pLA• ~ .
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- 'Z9 FEB~ 26 ~ PM 3.40
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- CLERK CiRCif1T COURT
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I FURTHER CERTIFY that I w>t7l register at my local address when the registration books reopen, and compb with all
j other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intxntion to return tom former domicile. and I intend to remain in
L u C 1 E County.
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Florida. permanents; . -
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i Saorn to sad subscribed before me this ~ day of
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_ A.D.18_ ~ /
ROGER POITRAS. CLERK OF CIRCUIT COl~2T
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ST. IE COUNTY; ft lOA
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. BY:
_ EPUTY LERK
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