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Deciaration of Domicile and Citiienship ,
TO THE CLERK OF THE C1RCUIT COURT. 4~;Sa5~~
ST . L UC I E COUNTY, FLORIDA: ~
This is my declaration of Domicile and Citisenship in the State of Florida thst I am filing this day ia sccordsnce. and in
conformity with Seetion 222.17. Florida Statutes. r
I v? as formerl a legal resident ot (%f}~_ L~~~ . ~ ~d I
~ ICity1 IStnL°1
resided at f~1 '~~1~ `O0 v~~vr . However. I have changed my clomicile to
IStreet aad NumEK)
/i.~ iin- ~ t ~.~s ~ sl day oi -
and am and have beea a bona fide resident of the Stste of Florida sincs r~•~
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f~~ _ 197~ _and I reside at f'3 0 ~ .So ~N~ /1 ~
" .V (Street and NumDer)
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f~, ~~r ~ ST . L l!G 1 E County. Fiorids,
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snd this statement is to be taken as my declaratioa of citizenship. actual legal residence and domicile in the State of Florida. >
If FOR THE PURPOSE OF ENROLlIN6 IF ~OR HONESTEAD PURPOSES~
CHIIOREN IN SCHOOL~ PLEASE STATE PIEASE CHECK: ~
THEIR NAMES.
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i I FURTHER CERTIFY that I will register at my local address when the tegistration books reopen. and comply with al!
~ other requirements of a legal resident of this State.
; I FURTHER CERTIFY that I have no intention to return to my iormer domicile, and I intend to remain in
~ T i U G 1 E . County.
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Fiorida, permanenti~ .
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Sworn to and subscribed before me this day of r L ~ 3~`~ v
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_ ~ , A.D.19_ ~9
3
ROGER POI TRAS CLERK OF C IRGUI T COl~2T
ST. LUGIE COUNTY, FLOR UA
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~ BY:
~ - EPUTY LERK
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