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Declaration of Domicile and Citiaenshi
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TO TILE CLEItK OFTHECIRCUITCOURT. '
S T. L UG I E COUNTY, FLORIDA:
This i! my declaration of Domicile and Citisenship in the State of Florida that I am filing this day is accordance. and in
conformity with Section 222.17. Florida Statutes.
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I was tormcrly a legal resident of " • -t h pr; , rim:, ~ _ ~h::rln ,T a ! r, ~ c21 1 and I
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resided at 171 ' : i h Se r. yi cc Aver ~ ie - However.I have ehaaged my domicile to
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an d am and have been a bona tide resident of the State of Florida since '~Iar c h ~ ~ a 1779 day of #
Sar 19 79 . and I wide at 420 P.aymoncl I~ne ~
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t S f- ~ , _~c ST. LUG I E Couot Florida
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and this statement is to be taken as my declaration of citisenship, actual legal residence and domic7e in the State of Florida.
IF iOR THE PURPOSE OF ENROLLING IF iOR HOMESTEAD PURPOSE5,
' CHILDREN IN SCHOOL, Pt.EASE STATE PLEASE CHECK:
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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 Slate. r
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I FURTHEZ CERTIFY that I have no intention tp return tom former domicile, and I intend to remain in
U C 1 E ,County.
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Florida, permanen~i~.
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4~~ Ray~• ~~t: I.anc ~ s
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~~~~GER POI TRASH CLERK OF CIRCUIT COURT
5~. LUGIE COUNTY, FLORIDA ;
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