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Declaration of Domicile and Citizenshi
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~•o •r11E CLEttIC OF THE CIRCUIT COURT.
ST. LUC I E COUNTY, FLORIDA:
This Is my declaration of Domicile and Citizenship in the State of Florida that I am tiling this day in accordance, and in
conformity with Section 222.17, Florida Statutes.
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I was for. mcr)y a legal resident of ~~,s I-a.(~"~" l and I
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resided at 2 2 ~ ~ ~ Vt'~u S~e C . However, I have changed my domicile to
(S aad NumDsr)
and am and have been a bona Gde resident of the State of Florida since ~ ~ ~ day of
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19 ~
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- and I reside at 2 1 O ( S -l.~G n I~ G ~ V C .
• (3trest and NumDsr)
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 domicile in the State of Florida.
if FOR THE PURPOSE OF ENROLt.fNG IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOt., PLEASE STATE PLEASE CHECK!
THEIR NAMESI
` ' FILED N'~D RECORDED=
LUCi~ CGU'~7Y. FLA.=:
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'79 NiAAR 26 P~1 3:40
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CLERK Ctkt:U1T COURT"
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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
I I FURTHER CERTIFY that I have no intention to return tom former domicile, and I intend to remain in
f U C 1 E ,County.
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Florida, permanenti;.
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~OV4. ~Y G,GGT,
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3 L G / (Name) ~ "
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RSx orn to and subscribed before me this'=~A6.~."_ day of
~ 79
RQGER POI TRAS, CLERK OF CIRCUIT COURT
ST. IE COUNTY, FLORIDA
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EPUTY IERK t~ ~ .
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