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Declaration of Domicile and Citizenship
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436616
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUC 1 E COUNTY, FLORIDA:
This b my declaration of Domicile eras Citisenshlp is the State of Florida that I am filing this day in accordance. and In
rnniormity with Section 222.17, Florida Statutes.
I was former a legal resident of ~~'Q Q~ o o ~'Q iV 1~ - and I
1 lar') 1~
resided at ~ ~ ~ ~ ~ ~ ~ , - However. I have changed my domicile to
(Street aad Number)
and am and have been a bona fide resident of the State of Florida since l• ' ~ 1` ~7 ~
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a r c.~ _ 19~.. and I reside at O $ A N ° c'~ 1. 1-4 t ~ r ~ y C- i
18treat and Numbed ;
_ r .
6' r c. ST. LUG 1 E County. Florida.
lacy) ~ '
and this statement is to be taken as my declaration of citisenship. actual legal residence and domicile in the State at Florida. !
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IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK! ~ "
THEIR NAMES! -
O a v:~ C t n w ~c'g'S ~~eqt S FiL~J tiND RECORDED
-T-- 436616 ~
'~a C t ~ S wa..z~y ~~.o~ 4$ '79 9 PM IZ . ~5
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I FURTHER CERTIFY that I w~l register at my local address when the registration books reopen, and oompl<j with all
other requirements of a legal resident of this State.
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" I FURTHER CERTIFY that I have no inteetion to return to my former domicile. and I intend to remain in ~
T. U C I E ,County.
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Florida. permanenu;.
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coy • :i ~ rn `~'-S ~ ~1`! 1111 S o ~ eS
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Sworn to and subscn'bed before me this ~ day of ~ ~ ~ ~
A.D.19_
7lt a~.~ ~9
ROGER P01 TRAS, CLERK OF C i RCU 1 T COURT
~ ST. LUGIE COUNTY, FLORIDA - •
BYZ ~ R ~l4 ~2~49
. EPUTY LERK SOO!t
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