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Deciaration of Domicile and Citizenshi
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° 4~334Q
TO THE CLERR OF THE CIItCUIT COURT,
ST. LUG i E ~p~y, ~,p~A: ,
This is m~ declantion oi Domie~e and GYtiunship in the State oi Florida that I am 51ing this dq in aooordanoe. and ia
eonformit~ w?itb Seetion 2?2.17. Floridi Statutes.
l .vus forme~ a ~egal res;denc oi ~~/fi~S ~e $ U ~l , /~~i~, tG ?~U il~ 1 .
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nsided at ~U lf ~''e ~1'• - How?ever. I 6ave ehangcd m,~ domic~7e to
(3tre~t aod Namb~r)
and am aad hsve been a bona fide nsident of tbe State oi Florida aince ~/r/ y 3~'~ daj of
y .19_L and I nside at l y~i L S~ ~O h y li ~
` ' (Str..t aad Nomb~) . -
P~ w~ / i ~ V G I G~ , ST . L UG 1 E /~.~wt~. LL~,_
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and this atatement ia to be talcen as my deeLntion oi c~~tizen~hip. setual legal maidenee and domicile in tbe State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF.POR HOMESTE/1D PURPOSES~
CHiIDREM IN SCHOOt~ PLEASE STATE PLEASE CHECKS ~
THEIR NAMES:
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Tr~A A.
CLERlI L'IRCUIT n
RFC4R0 \'ERIFIE~_ 5~
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; ~ FUBTHER CERTIFR that I~v~l regiater at my local addresa when the registntion books nopen, and oomply writh aU
i otber requirements d a legal resident of th~s State.
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I FURT~~ER CERTIFY that I have no intention to return to m former domide. and I intead to remain in
T. U G i E ' .~~ty.
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~ F7orida. permanenu;. ~
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K Sw+orn to and subsrnbed before me this ~ day of ;
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; ROGER P01 TRAS. CLERK OF C IRCUt T COt~2T
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~ ST. L UG I E COUNTY, f LOR 1 DA ~ '
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~ EPUTY LERK (J R '
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