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Dec~aration of Domicile and Citizensh~p ~
~35Ei'73
TO THE CLERK OF THE CIRCUIT COURT. .
ST. Ll.'G I E CpUIVTY~ FIARIDA:
1`his is my decluation of Domie.~e and Citizenship iA the State ot rida that I am filin thIs day in accordance. and in
conformity with Section 222.1~. Florida Statules. ~~G~~~~~~, p~ S •
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I wss tormerl a iegal resideat of ~ ~ ~ I
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~S;a~a ,t • 3- However. I have changed my domicile to
aad Numb.t)
and am and have beea a bona Cde resident oi the Stste oi Florida ainoe ~ ~ ~'S d~y
_ 19___La and I reside at ~ n"a ~ - .
l3trt aod Numbes) ?
~G~!` f~i~ Q/Y' l° ST . L UG I E Count~. Florida,
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and this statement is to be taken as nlY declar~tioa of citizenship, aetual legal reaidence and domicile in the State of Florida. ~
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IF fOR THE PURPOSE OF ENROILING IF FOR HOMESTEAO PURPOSES~ ~
CHIIOREN IN SCHOOL~ PLEASE STATE PIEASE CHECKS ~
TtiE1R NANES:
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c~~ ~G ;.'~D ~ECORCED
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- - 43~'73
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j I FURTHER CERTIFY that I will register at my local address when the registratioa books reopen, and comply with all
other requirementa of a legal resident of this State.
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~ I FURTHE~ CERTIFY that I have no intention to nturn to my former
d_ omicile. and I intend to remain in
` T 1 u C 1 E ~ County.
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~ Florids, permanen~i; . ~
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~ Sworn to and subscn'bed before me this ~ dsy of
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_ r, . A.D.19_ ~9
~ ROGER P01 TRAS, CLERK OF G I RCU I T COl~2T
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~ ST. LIJC i E COUNTY, FLOR 1
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~ BY:
~ EPUTY LERK
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4 A(~ 7
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