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Declaration of ®omicile and Citizenshi ~
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439938
TO Ti1E CLE1tK OF THE CIRCUIT COURT.
_ ST. LUC 1 E COUiwrY. FLORIDA:
This Is my declaration of Domicile and Citi=enahip in the State of Florida that I am tiling this day in accordance, and in
conformity with Section 222.17. Florida Statutes. ,,Q~,,
I was for_ mcrly a legal resident of _ ~~`''~~h~~w_•-' ~ and I
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resided at ~ 9 ~ ~ _.l.lC~.~ Q~~ - However. I have changed my domicile to
(StEe~t sad NuEOAarI -
and am and have beoa a bona Cde resident of the State o[ Fbrida since a~ 9 7 g day of
18__. and I reside at a 14 ~ C~ ~ • Jfi~. _ _ .
. lStEwt sad I~um0~r1
~ ~ ~ . ST . LUG I E County. Florida,
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and this statement is to be taken ss my declaration of citizenship. actual legal residence and domicile in the State of Florida.
IF.t:OR THE PURPOSE Of ENROLLING IF FOR HOMESTEAD PURPOSES,
' CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THE I`R MANES:
~iLcD ANU RECORDED
• ~ ~ ~+E r, ~ Ui:TY FLA..
- 439938
'79 AFR 5 AM ~ .43
I FURTHER CERTIFY that I will register at my local address when the registration books reopen. and comply with all
i other requirements of a legal resident of this State.
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- I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
J UCtE
County.
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Florida, permaneati;.
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orn to soil subscribed before me this ~ day of tp
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A ROGER POITRAS. CLERK OF CIRCUIT COURT
ST. LUGIE COUNTY, FLORIDA
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~ EPUTY I.ERK
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