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Deciaration of i~omicil~ ar~d Citiz~nshi~
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i 0 TlIE CLEltK OF' TNE CIRCUIT COURT. ' ~
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ST. L UG 1 E ~ op~ry~ fI,pR1DA:
This b my declaration ot Domteile ~nd Citizenship in the State of Florida lhat I am f~ing this daJr in accordance. and in t
contormity with Scction 222.1T. Florida Statules.
1 wu for~mc~y_rl a kgal re~idenl oI and I
t(~ty) lStat~)
resided at (~Q - How?ever. I have changed m~? domicile to
(Stre~t aed Numbsrl
snd am and have beon a bona tide residont of the State ot Fbrida aince dy? ot
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19 and I raide at ~
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~ ST . l UG I E County. Floreda.
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and this statement is to be taken a~ my declaration of citiunship. actud legal reaidenee and domie~e in the State oi Ftorida.
IF.iOR THE PURPOSE OF ENROLLING IF i'OR HOMESTEAO PURPOSES~
' CHIIDREN IN SCNOOL~ PLEASE STATE PLEASE CHECK: ~
THEIR NAMESS
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. ~?;~c~J t`:~ RECORDED
. ~'Jr~= "~Ul~S''Y, FLl.':
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' I FURTHER CERI7FY that I wilt register st my local addnss when the registntion books reopen. and eomply with all ~
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other requinments of a kgal nsideat of this State.
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~ . I FURTHE~ CERTIE'Y that I have no intention to return to m former domicile. and I intend to remein in
. U C 1 E . County.
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! F'larida, permsnenti;.
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~ Sµ~orn to and subxrybed before me thi~ da of ~ .
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3 r:OGER P 1 AS C ERK OF C IRCUI T COl~2T -
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~ S T. L UG I E GOUNTY, f LOR 1 UA
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~ EPUTY LERK bC~~~ ~ ~
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