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Declaration of D~micil~ ar~d Citiz~~shi~a 4~-~s9 :
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TO TlIE CLE1tK OF THE CIRCUIT COURT. '
ST. LUC 1 E (~UAITy~ F'I,QRIDA: ~
This b mr deelustion ot Domicile and Citisenahip ia the State ot Florida that I am filing th~s day in accordsnce, and in
contormitr with Section 222,17. Florida Statutes.
I was tormcrly a kgal reaident of s_ ~?/~~G.f 7''Gl'~ , ,(Q~ - and I
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res;ded ri~~~~~ ~n .~/iDs .t - HoMever. I have chaaged my domieile to
(St~srt and NumDed
a nd am and have beea a bona tde reaidenl oi tbe State ot Florida sinee T_ ~~~1? day of
,1'~dL/P.~N./~U ,19~1. and I reside at 7 S l~.~ `S T
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ST. LUG I E Couacy._Florida. .
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and this statement is to be taken u my declaration of citizenship. adual legal reaidence and domia'le in tha State of Florida.
IF FOR THE PURPOSE OF ENROLIING If FOR HOMESTEAD PURPOSES~
' CHIIDREN IN SCNOOL~ PLEASE STATE PLEASE CHECK: ~ ~
THE IR• NAMES:
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S'. ~UC~E COUNTY. FLAI
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43...~659 ~
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CLERK CIRCUlT COURT.
I FURTHER CERTII~'Y thaL I wai ngister at my local address ~rhen the registration books nopen, and eomply with all
! other requirements of a kgal resident ot this State.
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~ - I FURTHE~ CERTIFY that I hsve no intention to return to my former domicile. and I intend to remain in
5. U C 1 E _ Couaty.
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~ Florida, permanenti;.
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~ Sw~orn to and subscn'bed beton me this 3~•L day ot
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. A.D.19_ ~9 ~
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~~OGER POI TRAS. CLERK OF C IRCUI T COl~2T ~~~~'~ifax•~.
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