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Declaration of Domicile and Citizenshi ~
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442.013
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG I E COUNTY, FLORIDA:
This is my deelantion of Domicile and Citizenship in the State of Florida that I am filing this day in aeeordanoe. and in
conformity witb Section 222:17. Florida Statutes.
I was formerly a legal resident of ' ~ and I
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resided at However. I have changed my domic~7e to
l3treet sad NumD~rl
and am a d have been a bona fide resident of the State of Florida since a~ d~ day of
19~ and I aside at 3
18w•~ sail Nambed
C~~,r.~
~ ST. LUG I E County. Florida.
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and this statement is to be taken as my declaration of citizenship. actual legal residence and domic~7e in the State of Fbrida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOLS PLEASE STATE PLEASE CHECK:
THEIR AMES:
442A13
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I FURTHER CERTIFY that I will register st my local address when the registration books reopen, and comply with aD
other requirements of a legal resident of this State.
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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,
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~ Florida. permanenti; . ~
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~ COUNT`
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Sworn to and subscribed before me this ~ day of _ ~ a+~~
A.D.19_ ~1
ROGER POI TRAS. CLERK OF G IRGUI T COURT
ST. LUG I E COUNTY, FLOR t OA
EPUTY LERK '
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