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Declaration of Domicile and Citizenshi
. P
- 4~43338
TO THE CLERK OF THE CIRCUIT COURT.
S T. L UG t E ~pv~y. ~,p~A: ,
This is m~ declanEioa ot Domiu7e and Clt~eaship in the State of Florida that I am filing this da~ in soocrdanoe, and in
eonformit~ w?itb Section 222.17. Florida Statutes.
I~vas form~*1, a legil resident of P,~,jc ~f'?,~,~p _ . ' .
and I
. 1(tit~l Stat~)
resided at •f ~//~n„Q+~~- v~.t . Aowever. I have ehanged m~ domie~e to
- (Stt~st Namb~r) ~
and am and have been a bona fide resident of the Stste oi Florida aince J~~ Q~: 7 9 ds~ of
' 19_~ and I nside at _ /f G~ ~R/~l.(
~ ~ ( e~t aed Nnmber)
~,~~y~ , ST. LUG I E ~ti.
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and thia atatement is to be taken aa m~ decLntion ot eitiun~hip. adud legal reaidence and domic7e in the State of Florida.
,
IF FOR THE PURPOSE OF•ENROLLING IF~ FOR HOMESTEAD PURPOSES~
CHIIDREN IN SCHOOL~ PLEASE STATE ~ P~EASE CHECK: ~
THEIR NAMES:
_~~~7~~ ~i~m~~L
- ~ 1919 NAY -4 Pk 2 03
' fi EO ANO RE~ORDEO • •
ST.~UCIE COUN Y.FLA. .
R06ER POITRAS
CLERK CtRCU1T COUR
- ' RECORO ~ERIFfE4_
. 9:43338
I FURTHER CERTIFY that I vvi71 register at my local addresa when tbe registntion books nwpen, and eompl~ .vit6 all
other requirementa of s kgtl resident of thi~ State.
~
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i I FUR1'AER CERTIFY tlut I have na IDtCAL10A to retnrn to my former domica7e, and I intend to remain in
' T. U C 1 E .~~ty~
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Florida. permanenu; .
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: S~vorn to and aabseribed befoir me this dsy of ~ L
~ A.D.19
; ~9 - ' -
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R ROGER POITRAS. CLERK OF CIRGUIT COl~2T
~ .
~ -
~ ST. COUNTY, fLOR10A ~ _
BY: ~ t ~ ~
~ . EPUTY LERK '
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' ~ b00K JV~ PAGE 7~ ' _
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