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Declaration of Domicile and Citizenship c~
442"lbt9
TO THE CLERK OF THE CIRCUITCOURT. -
ST . L UG I E COUNTY, FLORIDA: .
This is my deelantion of Domicile snd Citizenship in the State of Florida that I am filing this day in accordance. and in
conformity with Section 222.1?. Florida Statutes.
I was formerll a legal resident of Lorain i o and I
(City) (State)
resided at 119 ' . 2 fi t h St r e c t , However. I have changed my domicile to
(Sweet and Number)
and am and have been a bona fide resident of the State of Florida since 17t ti day of
April ,19?~7.~ndIresideat 2145 S. E. Shelter 7rive
13trest and Nambar)
T_'ort St . L~ ~ cie ~ ST. LUG I E County. Florida,
Ilxty)
and this statement is to be taken as my declaration of citizenship. actual legal residence and domict~e in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CNECK:
THEIR NAMES:
Judith Anne I:ob~~~~
1919~AY-I PM~26
FILED AMO RECUItt)EO
ST,LUCIE CO~NtY.FLA.
cis
aacult
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RECORD VERIiIEt~~ '
442'7~y
I FURTHER CERTIFY that I wt71 re ' r
gate at my local address when the registration books reopen. and comply with all
! 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,
E' (City) -
E Florida. permanenti; .
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. f ~.J~ I'.oss A. ~To~~•'.~~y
~ (Name)
J y.f.~C 2145 S. E. Shelter ~r
Sworn to and sobsm'bed before me this ~ day of ~ o r t ; ~ . I.u c i c ~ 1 a . ~ ~ 345 2 -
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ROGER PO I TRAS. CLERK OF G i RGU I T COURT
ST. LUGIE COUNTY, FLORIDA - -
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BY: ~ a
- EPUTY LERK ;
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