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Dectaration of Domicile and Citizenship ~
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TO THE CLERK OF THE CIRCUIT COURT.
ST. LUC I E COUNTY. FLORIDA:
This is my declaration ot Domicile and Citizenship in the State of Florida that I am filing tAis day in accordance. and in
conformity with Section 222.19. Florids Statutee.
I was tormerlv a Tegal resident of _s-~n.~--^~'~ -@ and I
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resided at 5 ~ 3 ~ ~ p~ . However. I have changed my domicile to
(Sveet and Number) ~
and have been a bona tde resident ot the State oi Florida since dsy oi
.19~2q~. and I reside at a~-~ - ~
' / (Street aad Numberl
~,~,a(~ ~ ST. LUC I E Couaty. Fiorida.
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and this statement is to be taken as my declaration of citizenship. actual legal residence and domic~e in the State oi Florida.
IF FOR TNE PURPOSE OF ENROLLING IF FOR HONESTEAD PURPOSES~
CHILOREN IN SCHOOL~ PIEASE STATE PLEASE CHECKI ~
THEIR NANESi
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i I FL'~tTHEB CERT~FY that I wi71 tegister at my loca! address when the registration books reopen, and comply with all
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~ other requirements ot a Iegal resident of this State.
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~ I FURTHE~ CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
i . T. U C I E , County.
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F Florida, permanen~i; .
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~ Sworn to and subscnbed betore me this ~ day of
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1--~ . A.D.19_ ~9
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` ROGER P01 TRAS, GLERK OF G IRCUI T COURT
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~ ST. LUGIE COUNTY, FLORivA
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~ ~ EPUTY IERK
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