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Declaration of Domicile and Citizenship '
4~43se
TO THE CLERK OF THE CIRCUIT COURT.
ST . L UC 1 E COUNTY. FLORIDA: .
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in sreordance. and in
conformity with Section 222.17. Fbrida Statutes.
I was formerly a legal resident of and I
resided at W,~v.~S~1r' ~ ~ . However. I bave changed my dou~icde to
(8treat and Nnmbarl
and am and have been a bona fide resident of the State of Florida since day of
~ ,19.2. and I reside at 7 A h S+ -
IStrsd and NamtKSl
_ ~or-'r c~ . L..lct~ ST. LUG I E County. Florida,
«xyl
and 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,
CHIt.OREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMESS
1919 NaY 15 AN ~ OS
FILED AMO Rf'COROEO i`
SLIUCIE COUl11Y.FLA.
C ERK CIRCUIT
OUS;~ Q.,
RFCORD YERIFIfD__ ~ _1~~
444368
I FURTHER CERTIFY that I wi71 register at my local address when the registratSon books reopen, and comply with all
other requirements of a legal resident of this State.
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. permanenti; .
E
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s
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7 S HDa a r S~
S} IN 1'4lC t e,-,y F ~ a
Sworo to and snbsrn'bed before me this day of 3 3'1-S Z
g ~ A y - .A.D.19_ -
79 . -
ROGER P01 TRAS. CLERK OF G IRGUI T COURT i,,:
-
ST. LUCiE COUNTY, fLOR1OA ~ -
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E PUTY L
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