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. ~ ~ ~ ~ CI~IZ~~'1S~1 ~
Declaration of ®~mic~le a d ~ ~
- X38'72'7
TO THE CLE1tK OF THE CIRCUIT COURT,
_ ST. lUG I E COUNTY. FLORIDA:
This is my declaration of Domicile and Ciltzenship in the State of Florida that I am tiling this day in accordance, ind in
conformity with Section 222.17, Florida Statutes.
I was formerly a legal resident o! ~ ~ /'U ~ and I
Citr) ~ tats)
resided at 1~4'a~ ~ ~ l . ~7 i[!C h ~ . Howover. I have changed my domicile to
(Street and Number) ~ Q
and any and have beon a bona fide resident of the State of Florida since y day of
_ ~ CC I1 ~ ,19~, and I reside at M~ ~ ~d~D/
(Street and Number)
, f ~~'L o~ _ ST. Ll1G 1 E County. Florida,
(Clt~)
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 ENROLLING IF FOR HOMESTEAD PURPOSES
' CHILDREN IN SCHOOLS PLEASE STATE PLEASE CHECKS
THEIR NAMESS
FILE[) 1,Np. RECORQEt)
. ~UCI~ '-~U~;TY. FLA.
438'72 ~ -
'79 MAR 27 PM I : 55
-
CLERK CINCUi'' COURT
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 FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ T. U C I E ,County.
(City)
Fio; ids, permanenti;.
i
ESNc LJ
~
9-~
_ _ Name) .
.~ho~ fir"
• (Address) 1 r
~ti•: orn to and subscribed before me this day of PhC' ' ~~T -`s
_ A.D.19_ ' ~ '
~ tom _ • .
E~OGER P01 TRASa, CLERK OF CIRCUIT COURT Nofa^,-Pubic, s.a+. of ~
A ill 4, 1980:'
My Commission 6rpircs P
S T . L UG I E COUNTY, F LOR 1 UA .~a . I,m. ~ic~n Fire a ca,,,axr_~ -
EPUTY LERK ~ t
p < < 3U5 - ~ ~ 254 . J;. '