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Deciaration of Dom~csle and C~t~zensh~p
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4.356U3
TO THE CLERK OF THE CIRCUIT COURT.
ST. Ll1G I E CpUNTY, FI,ORIDA:
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This is my declaratioa of Domicik and Citlseasbip in the ~tate of Florida that I am filing this day in accordsnce. and in ~
coniormity with Section 222:17. Florida Statutas.
I was formerls a tegal resideat of ~ ~ I
ICit71 ~ lStat~)
resided at ? . However, I have chsaged wy domic~e to
t aod Nacobu)
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and am snd hsve been a bona C~de resident ot the State ot Florida aince ~ ~ dsy ot
__.19~. and I reside at • ~ - `
~ .ud Numbr) . ~ ~
~ ST. LUG I E Count~. Fiorida, !
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and this statemeat is to be takea as ~y deelaraUon ot citizensAip. actual legd residence and domicile in the State of Florid~. ~
IF FOR THE PURPOSL~ OF ENROILING If FOR HONESTEAD PURPOSES~ ~
CHIIOREN IN SCHOOI~ PIEASE STATE PI.EASE CHECKS ~ v, +
THE 1 R NAMESL
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~,C' ~ ,..U?aTY ri ' .
4:~.54iO~~ ~
~19 FE~ 2a A~~i i y '
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' 1 FURTHER CERTIFY that I w~71 register at my local address when t6e registntion books reopea, and eomply with all
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f other requirements of a legsl resident of this State. ~
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~ I FURTHEa't CERTIFY that I hsve no intxntioa to return to my fotmer domicile. and I intend to remain ia
E ~ ~ r i u c 1 E , Covnty.
„ IC'~t)1 . ~
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~ Florida, permanenci~ .
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Sworn to and subscr'bed before me this ~ day of
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_ _ -r ~ . A.D.19_ ~9
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ROGER P01 TRAS. GLERK OF C IRCUI T GOl~2T
ST IE GOUNTY, FLORIOA ~ . .
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~ BY. ~..,-k <
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~ EPUTY IERK
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