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Declaration of Domicile and Citizenship
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TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG i E COUNTY. FLORIDA:
This u my declaration of Domicile and Citizenship is the State of Florida that I am filing this d~? in accordance. and is
conformity witb Section 222.17, Fbrida Statutes. a
I was former) a legal resident of ~Ddr ' I ~ r< < F~ t9 Li
~o~. and I -
ICKr) lstatd
resided at I 1 I O ~ • ~ 3 n d S • - However, I have changed my domiu7e to
• (3teeet aad NumDst)
and am and have been a bona fide resident of the State of Florida since S,~ day at
3 f 19 G ~ _ and I reside at / ~ ~ a~Qr' d ~ ~ .
ISer+at and Number)
D ~ ~ ~ ~ • t rL c _ ST . LUG I E County. Florida,
171
and this statement is to be taken ss my declaration 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 CHECK: ~ {
THEIR NAMES:
^rC0~CE0
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I FURTHER CERTIFY that I wdl register at my local address when the regisltation books reopen, and comply with all '
other requirements of.d legal resident of this State.
I FURTHER CERTIFY that I have no intention to return tom former domicile. and I intend to remain in
. T. U C I E ,County,
(City) ,
t
Florida. permanents; .
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Swora to and subscribed before me this r ~ day of
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C.~1~ , A.D.19_ ~9 •
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ROGER F'OI TRAS, CLERK OF G IRGUI T COURT
ST. LUG COUNTY, FLORtUA - _
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UTY LERK -
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