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Declaration of Domicile and Citizenship - ,
TO TIIE CLERK OFTHE CIRCUIT COURT. 3~j~d
.
ST. LUG I E COUNTY, FLORIDA:
This V my
declaration of Domicile and Citisnship is the State of Fbrida that I
un filing this day is accordance. and In
conformity with Section 222.17, Florida Statutes.
I wu IormerlY a legal resident of = ~i9 !/.~f~~/11 SS ' and I G~
~ / ~yl ~ IStat~
resided-at /vIGyO~ ASS O~ D _ However. )fhave changed my domiu7e to
(3tre~t and Nuaetterl ~ p/~
and am and have been a bona Gde resident of the State of Florida siaoe ~'Q day of
/T ~Pl
e~i~- ,19~ and I reside at a ~ 0~ - ~~i~i~
l3te..e sad Numtrrl
G%• S T. L UG i E County, Florida,
lCtt~l a d~C
and this statement is to be taken u my declaration of citizenship, actual kgal residence and domiu'le in the State of Florida.
IF.iOR THE PURPOSE OF ENROLLING IF iOR HOMEStEAO PURPOSESa
' CHiI.DREN IN SCHOOIr PLEASE STATE PLEASE CHECK:
THEIR NAMES:
~~.fLD~~'.rI ~~-i:C sr~~~ RECORDED
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j I FURTHER CERTIFY that I will register at my local address when the registration books reopen. aed comply with all
other requirements of a legal resident of this State.
~.~E WE
ff I FURTHER CERTIFY that I have no intrntion to return tom former domicile. and I intend to remain in
U C 1 E ,County.
v y
Florida, permanenti;.
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Scorn to and subscribed before me this ~ day at 1 / ~ _ - ~~~C~
Q~ 9 -
s A.D.19_ ~I
ROGER POI
TRAS~CLERK
OF CIRCUIT COURT ~Cry~~ ~ •
. Ne~r~v ~v tic. Snob of HoridO AF L~.-
ST. LUGIE COUNTY, FLORIDA
Mr Comm~sston Expir.s Apr}I•~'19~~'•.
bnd.d br Amsricon fita6Qr
EPUtY LERK ~ - • 'y• - ~
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