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Declaration of Domic~le and Cit~zensh~p
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TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E COUNTY, FLORIDA:
Thia is mp declaration of Domicile and Citizenship ia the State of Florida that I am filing this day Ia accordance. and in
conlormity witA Section 222.17. F'lorida ~tutes.
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I was formerl a iegal resident o! ~6 and I
1Cit~) IStabl
resided at `~*'t-'Z-L~"~~~ . However. I have changed my domieile to
IStreet ~nd Nnmber) '
and am and have been a bona fide resident of the Stste of Florida since day ot
09 ~ w - .
.19 . aad I reside at .
(Steeet aad Num
~.p~+~-~P _ ST. LUG I E Co~nc~. F'lorid~
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and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State oi Florida. ;
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IF fOR THE PURPOSE OF ENROLIING IF FOR HOMESTEAD PURPOSES~ i
CHILOREN IN SCHOOI~ PLEASE STATE PIEASE CHECKS ~
THEIR NANES:
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~ I FURTHER CERTIFY that I will negister at my local address when the registration books reopen, aad comply with all
~ other requirements of a legal resident ot this State.
¢ I Fi1RTHE~ CERTIF'Y thst I have no intxntion to return to my former domicile, and I intend to remain in
~ _ ~ T 1 u C 1 E _ _ County.
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Fiorida. permanenti;.
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Sw~orn to and subscnbed before~me this / - day oi ~Z F L~a . 3 3~s s
v ~~~CLt_ . A.D.19_ / 9 ,
~ ROGER P01 TRAS, CLERK OF G IRGUI T COt~2T
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~ ST. LUGIE COUNTY, FLORIOA : .
~ BY:
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EPUTY LERK ~
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