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Declaration of Domicile and Citizenshi y~
P
. 41.824
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E COUNTY, FLORIDA: .
This is my declaration of Domicde and Citizenship in the State of Florida that I am filing this day in aooordance. and in
conformity with Section 222.17. Florida Sta~tut)es. I
I was tormerl' a legal resident of - iQ ~K t U I l
~'e _ _ / ~ I~ n and I
1(.tityl 13tate)
resided at G - ~ 3 y ~ . However. I have changed my domicile to
(3t++eet sad Numtwl
and am and have been a bona fide resident of the State of Florida since ~ ~ day of
• . i9_L`~. and I res;ae at 5 lie n n n ~rJ~
/ cstre.t ana Namber)
r ~ ~~7 • G(c / ~ sT . L UG I E County. Florida,
lat,l
and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR .NAMES:
~ 1oh n ~ cv .
~ 1.
s79 ! ' [ ~ p;.j I i :119
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 State.
I
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
_ T. U C I E County.
IGtity1 - s
Florida, permanenti; .
F
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Sworn to and subscn'bed before me this ~ day of 0 Y ~T • GC C
. A.D.,19_ I / .
ROGER P01 TRAS. CLERK OF G I RGU I T COURT
ST. LUG 1 E COUNTY, 6L'QR 1 OA
,
BY : cuWS
EPUTY LERK
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