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Declaration of ®omicile and Citiaenshi~ ~
- 438'58
'1'0 T}IE CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E COUNTY. FLORIDA:
This b my declaration of Domicile and Citizenship in the State o[ Florida that I am filing this day in accordance, and in
conformity with Scclion 222.17, Florida Statutes.
1 was former) a legal resident oi-- ~ ~ N Te ~ ~ / and I
lpty) lState)
resided st ~ ~ G 7 C ~ 0 F f ~ rt p R. , However, I have changed my domicile to
(Street sod Number)
end am and have boon a bona tide resident of the State of Florida since ~S ~ day of
~A N y ~ A `l ,19_2, and I reside at ~pt 3 ~ ~/GOO N'~ • ~ e ~ ~ N
. l3trest and Number)
ST. LUG I E County, Florida,
tats)
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 SCHOOIa PLEASE STATE PLEASE CHECK:
THE 1 R NAMES: 1---~
F:t_ED nNG RECORDED
.4
,79 27 ~N 2 ~ 3y
C~~RK C~RCU!T COORS.
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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.
9 a. FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain in
, t . t_ ~ ~ t ~ ,County.
lCit~)
t: iorida, permanenti;.
~'~Ou''~Tr `ht
e[" : ' ~
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~L2 ll/te,Y
_ _ (Name)
' (Addroaa)
~ ~v: ern to and subscribed before me this ~ day of ?E'/VSEN /3 t~ A~'N F'~-~ ~s1
ROGER POI TRAS. CLERK OF CIRCUIT COURT
ST. LUG COUNTY, FLORIDA
~Y:
EPUTY LERK
3~-P~ ~U5 :-2638