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Declaration of Dom~c~le and Citizenship
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TO THE CLERK OF THE CIRCUIT COURT.
_ ST. LUG I E COUNTY, FLORIDA:
This is RU' decluation of Domicile ana Citizenship in the State oil Florida that I am Sling this day in accordance, snd in
conformity with Section 222.17. Florida Statutes.
I was for,. merly a legal resident of D ~ /l~ ls, ~C~E~ ~ E~2.SE ~ and I
(C.ty) (State) ~
resided at J!' 1~{~'l~~ ~ E T lt/A- y _ However. I have changed my domicile to
(Street and Number)
and am and have'been a bona fide resident of the State of Florida since 2 ~D day of j
NI ~cEf .19
7
9 _ and I reside at 17 SU12C ~4~ D Y L~^-~E
(Stiwt and Number)
POIe T 5 T L v G[ E S T. L UG I E County. Florida,
IGt7)
and this statement is to be taken as my decluation of citizenship. actual legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES, ~ `
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS ~ ±
THEIR NANESS
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to returo to my former domicile. and I intend to remain in
T. U C I E County.
ICit~)
Florida. permanenti; .
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Sworn , • d~subscn'bed before me this ~ day of (~01e-T 3T• L.~J L~ E ~ L
l' _ A.D.19_
ROGER POI TRAS, CLERK OF G IRCUI T COURT
ST. E COUNTY, FLORtO
BY:
<<
EPUTY LERK
. ~ soon 3U4 ~c~ 1786
E Arn Form 71 ~
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