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Declaration of Domicile and Citizenship ~
441592 ~
TO THE CLERK OF THE CIRCUIT COURT.
ST . L UC i E ~pU~y. ~,p~A:
This is my decluation of Domieile aad GItisenship in Lhe StaLe of Florida that I am tling this da~ ia aocordance. and in
cor~formity wit6 Section 222.17. Fbrida StacuLes. . .
I was lormerly a 1ega1 resident at /y aad I
. 1(ltll • fState)
resided at ~ ' . fto~vever. I bave cbanged m~ domieile to
(Str.~t aad Numb~r)
and ua and have beea a bona Sde resident ot tbe S4te oi Florida sinee ~ da~ ot
.
-19_.. and I re~ide at r 3S ~ ~
, (8tre.t aad Nom
,~rt~.i ST. LUG 1 E ~ti~
.
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and this stateri?ent is to be taken as my decluation of citiun~hip. actual legal residence and domidt in the StaLe of Fbrida.
IF FOR THE PURPOSE Oi ENROLLING IF fOR HOMESTEAD PURPOSES~
CHI REN IN SCHOOL~ P~EASE STATE PI.EASE CHECKS ~
THEIR NAME 2
~F~OR~~D
' .~~J;i. ~y
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44~.592
'79 u~`' Z 0 AM 9~ 5 Z
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' I FURTHER CERTIFY that I wi71 ngister at my local address whea the registration books reopea, and oomply with ali
~ other requirements of a legal resident of thi~ State.
i
E I FiJ~1'HER CERTIFY tlut I have no intention to return to my former domicile. and I intend to remain in
~ T. U C 1 E .~~ty.
~ • lC+t~l
° -~lit~C'_P -
~ Florida, permanen~i; .
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~ S~vom to and subsrnbed before me this day of ~2,3->> ~~io r
_
~ • ~ A.D.19
; ~9 , ;
ROGER P01 TRAS. CLERK OF G IRCUI T COt~tT
7 .
~ ST. Ll1G i E GOUNTY, fLOR 1 OA '
~ BY: ` . / ~ '
r
E G?GG~iv • - • . .J
~ . EPUTY LERK ' _
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~ ~ ~307 ~ ~9 ' - ~
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