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Declaration of Domicile and Citizenship ~ ~
4.42115
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG I E COUNTY. FLORIDA: .
This is my declaration of Domic~7e and Clti:enship in the State of Florida that I am filing thin day in aocordanoe. and in
conformity with Section 222.17. Florida Statutes.
~ '
I was fob a kgal resident of _ ~ ~1C A Bi c ~ ~ ~ O, G r-l ~ / sad I
((qty) (8tatel
resided at ~'e S ~ ~ ~ y ~ ~ d . However. I bave clanged my domicile to
(Btr+Nt asd NambN
sad am and have been a bona Sde resident of the State of Florida since f ~ U G.. k. ~ I r'I ~ tl day of
12 19 ~ - and I reside at ~ I z 3 f~ C A MC ~ q A u t. n~~
Isa..e.naNnme«rt
~U -f - ~ ~ ~ t ~ ~ ST . L UG I E County. Florida,
t(~ityl
and this statement is to be taken as my declaration of citizenship. actual legal residence and domiale in the S4te of Florida.
IF FOR. THE PURPOSE Of ENROLLING IF FOR HOMEStEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
442115
'79 t~FR 25 AM I i : 15
9~
I FURTHER CERTIFY that I wt71 register at my lots! address when the registration books reopen, and comply with ill
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no Intention to return to my former domic~7e. and I intend to remain in
T U C E County,
((tity) _
~ Florida. permanenti; .
f
f
g J~~r~ COtlNly
~'r
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~FCOUNTV.F~ (1~ (_ay ~ TR T I _ P n ~ ~ -:t
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e
F (Name}
z / ~ (Addrew)
F Sworn to and snbscn"bed before me this ~ -S day of
' --9
ROGER POI TRAS. CLERK OF G IRGUI GOURT
ST. LUGIE COUNTY, FtORtOA
BY: ~ f,
' _ EPUTY L.ERK '
so~K ~acE 1759 . ' '
_