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declaration of D®micila and Citizenship y~
' X39953
TO TILE CLEItK OF THE CIRCUIT COURT. '
ST. LUC 1 E COUNTY. FLORIDAs
This b my declaration of Domicile and Citizenship In the Stats of Florida /hat I am filing this day in accordance. and is
conformity with Section 222.17. Florida Statutes.
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I wu formerly a legal resident of ,,L,LNN'~~v~GV'~ ~Owr~ o~~i'i S fp ~ ~~Q/j-~ P and I
TT (CYt) l3tate)
resided at M~ Tu a'~4 rl ~ S~dvE' a a (No rlunr 6~ r~ _ However. I have changed my domicile to '
(Street sad Number) ~
a n d am and have been a bona Cde resident of the State of Fbrida since e'D J ! ~''S ~ C / ~ day os
~ ~ ~ 1~~~. and I reside at L~,¢S~Q 1/SI70~'~° ~r~ /4.bf" a ~•~f
- IStrset sad Number)
~"U ~l~I' ~ ~ ST. LUC 1 E County. Florida.
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and this statement is to be taken u my dee4ration of citizenship. actual legal residence and domicile in the State of Florida.
IF,FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSESa
CHILDREN IN SCHOOLa PLEASE STATE PLEASE CHECKS ,~j 1
THEIR NAMESS ~ , ~
• L, c;F LORDED
453
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply with all
aiher requirements of a legal resident of this State.
I
i i FURTHER CERTIFY that I have no intention to return tom former domicile. and I intend to remain in
T U C I E ,County.
Florida, permanenti~.
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P`p~ (Name)
~'cW«i~r. F~° / S DLL r'.5/'li_~~-r`' !/y'/!/L~ f ~0¢
Sworn to and subscribed before me this ~ day of ~O? ~ f / [d' I"~ ~~4 • 3j ~-~li
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. . A.D.19_ ~
RQGER P01 TRAS. CLERK OF CIRCUIT COURT
~ ST. LUG I E COUNTY, F>_OR t UA
EPUTY LERK
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