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Declaration of Dom~c~le and. C~t~zensh~p
444251
TO THE CLERK OF THE CIRCUIT COURT.
S T . LUG 1 E COUp'rY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance. and in
conformity with Section 222.17. Florida Statutes.
I was formerh+ a legal resident of Q e~ ~ ~ 1 1 d ~d I
(City) (State)
resided at 3'41 S I~ lG C-, 5 n . Howrever. I have chsnged my domict7e to
IStreet and Nnmber)
and am and have been a bona fide resident of the State of Florida since j' day of
~`r .19, and I aside at I 1~_1~ -i' l~ ~n~ f1 ~A ~
(3tre~t cad NomDa)
. j ~~cl~ ST. LUG I E `
County. Florida.
«aty)
and this statement is to be taken as my declaration of citizenship. actual legal residence and domict7e in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING If FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
- -
19j9 NAY 14 AN i I ~ 08 a
- FILED AND RECOYRDEO
S ROGER
PO
TRASA~
' CLERK CIRCUIT CO a
RECORD YCR:FI~"
- 444251 3
. t
I FURTHER CERTIFY that I wt71 register at my local address when the registration books reopen. and comply with ill
other requirements of a legal resident of this State.
i
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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. -
ICity)
Florida. permanents; .
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- Sworn to and subsen'bed before me this ~ day of ~r , 2 ~-i'.
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_(1f ~ ~L~a _
~Q~ ~ . A.D.19_ -
- ROGER PO I TRAS. CLERK OF G I RGU I T COURT
~ ST. LUG 1 E COUNTY, FLOR i OA
BY: ~ '
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_ _ EPUTY LERK
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