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Declaration of Domicile and Citizenship ~c{~
44'721
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG i E COUNTY. FLORIDA; ~ .
This is my declaration of Domietle and Citizenship in the State of Florida that I am filing this day in accordance, and is
conformity with Section 222:17. Florida Statutes.
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I was formed, a legal resident of ~
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resided at 7 /.S •`O%S ~~i9C~" _ X03 However. I have changed my domie~7e to •
ISt:rat and Nnmbad ,ST
and am and have been a bona fide resident of the State of Florida since day of
° ~~ol ~~•P~ i~~ y
i~%~lG• ,19 ~ ~ . and I reside at
. (8traat and Nome.rl
~E.PCE ST. LUG I E qty, ,
IptJ)
sad this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES
CHI~LOREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
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-1919 SAY -8 P!I 2~ 38
FI EO ANU k~CUkUED
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RO~Ca
IER
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TRASA~
CLERK CIRCUIT C
R'cCCRO \'fR1FIEC._
44'721 •
I FURTHER CERTIFY that I wi11 register at my local addrrss when the registration books reopen, and comply with all
other requirements of a legal resident of this State.
t
I FURTHER CERTIFY tbat 1 have no intention to return to my former domica7e. and I intend to remain in
T. U C I E ,County.
ICityl
Florida, permanenu; .
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Sworn to and snbsen'bed before me this day of % l 3~y~ ~
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~QiH ~ A.D.19_ ~1
ROGER POI TRAS, CLERK OF G IRCUI T COURT
ST. L UG I E COUNTY, FLOR 1 DA
BY: _ ` i ~
_ EPUTY LERK
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