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Declaration of Domicile and Citizensh~~
~:3~6041
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG I E COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance, and in
conformity with Section 222.17, Florida Statutes. ~j ~ ,,Q n
I was former( a Tgal resident of s ~ . o ~ ~ ~ ~ I
(Cit71 (State)
resided at ~ ~ ~ ~ ~ ~ t 4 Q •a. 1 J • How ever, I have changed my domicl7e to
(Street N~mbet) i
and am and have been a bona fide resident of the State of Florida since m ~ ~-C ~ 3 - day of
/1'1 ~ K C' ~ ,19 ~ r - and I reside at 3 15 3 R ~ ~ e R fl 4~ ~ ~
(Streatand Numbed
~ 1 P K e e~ _ ST . L UG I E County. Florida. ,
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domiu'le in the State of Florida.
' H MESTEAD PURPOSES
Ii FOR THE PURPOSE OF ENROLLING If FOR 0 s }
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR N A M E S S 1---------~~ '
D d Lo ~ ~ 1j0t S y r e~ ~ (L r C n , E C O R ~ D
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen. and comply with all ~
j other requirements of a legal resident of this State. ~
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E I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in i
~ r ~ U G I E _ _ County.
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Florida. permanents, .
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cOUN~
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(Address)
Sworn to and subscr'bed before me this ~ day of
G~~ _ A.D.19_ ~ /
y ~
ROGER P01 TRAS. CLERK OF G I RGU_ i T COURT - €
ST. LUGIE COUNTY, FLORIDA -
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Btr. ,
- EPUTY L.ERK
- X304 ~109~'
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