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Dectaration of Dom~cile and Citizensh~p
.435951
TO THE CLERK OF THE CIRCUIT COURT.
ST. L UC 1 E Cp~y, ~,pRIDA;
This Is my declar~tioa of Domice7e and Citizenship in tAe St~ta of Florids that I am 61ing this day in accordance. snd in
conformity wilh Section 222.17. Florids Statutes.
I was formeri~ s Iegal resideat ot h O O k i~ ~ ~ v~ o~ S an~ I
tC'it~l (Stat~
resided at a~ 5 ~,t~~ ~ S$ O . However. I tuve changed my docnicile to
l3treet acd NumDer)
and am and have been a bona 5de resident of tl~e State of Florids siaoe ~Gb 1e * 1 a'7 9 a,r ~ ~
. l9 . and I reside ~t ~ ~ ~ ~ ~ ~ I,LI~ '
t
(Stre~t aod Nna? )
F't • P i~ C ft(~ ~ ~ M ST . L UG I E County. F~oriaa, '
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and this statemeM is to be taken aa my declaration of citizenship. aetual legal residence and domiu7e in the State of Ftorida.
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IF FOR 7HE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES~ ?
CHILOREN IN SCHOOL~ PIEASE STATE PLEASE CHECK:
THEIR NAMES:
Wp_ ~ec,ken~ ~•Q!~_ ' -
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~ 435?951 ~
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1 FURTNER CERTIFY that I w~l register st my loca) address when tha regisiraiioa books reopen, and comply with all
o±her requirements of a legal resident of this Siate. f
I FURTHER CERTIFY that I have no intention to retum to mp former domicile. and I intend to remain in
" - ' . 5T . L U C 1 E . County.
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Florida, permar.encl; .
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Sworn to and subscn'bed before me this ~ day of~ ~ •
, A.D.19_ ~9
ROGER PO I TRAS, CLERK OF C I RCU I T COt~ T .
ST. Ll/CtE GOUNTY, FLORiOA
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