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Declaration of Domicile and Citizenship
44~i398 ~
TO THE CLERK OF THE CIRCUIT COURT,
ST . L UG 1 E ~p~y. ~,p~A:
This is m~ deduatioa oi Domieile aad Citiunship in the State oi Florida that I am filing this day in aocordance. and in
conformit~ ~vith Seetion 222.1T, Florida Statutes.
I wis formerly s legal resident of _~f-~a ai~~ ,/Y~s~ '
e~.l~ ind i '
((,l't~) 13tate) ~
resided at f 3! G,~n~d
~(~/_b.xr . However. I have etianged my domicile to ~
~scn.~ ~a N~e~~
and am and have been a bons fide resident of the SLte of Florida since ~S day oi
~~~'u ~'1 .19 7 Q - and I re~ide at y S 7 rh
18tiesc aod Namber)
,~-T_~i ~-c ~ ST . l l1C I E Count~. Florida,
IAt~)
and this statement is to be taken as my declaration oi citiunship. adual legal reaidence and domie7e in the State oi Florida.
IF FOR TIiE PURPOSE OF ENROLIING IF FOR HOMESTEAD PURPOSES~
CHIIOREN IN SCHOOL~ P~EASE STATE P~EASE CHECK: ~
THE1R NAMESL
~ir~~ JesL:,
~ ~1•~ J~ _~1. ~
i979 i~4Y 18 PH 2~ 27 ~
~ILEO AHD Ft~Qk~EO
' s ROOER Q R4S ~
CLERK CIRCUIT COliR', :
RECCRD V~RIFIF~_ _ ~_~~~2.._ '
444_89~3
I I FURTHER CERTIFY that I w~71 register at my local addresa when the registration books reopen, and comply witb all
; other requirements of a legal resident of this State.
i
j 1 FURTHEft CERTIFY that I have no intention to return to my former domic~e, and I intend to remain in
T. U C I E .~~tp,
~ ICit~) _
~ Florida. permanenti;. Fot ~ ~"r
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' ~ 86idrii.~o and snbscn'bed before me this ~ day of ~O I-~ ~Ilr
! I a ! . A.D.19_ / 9 _ _
; ROGER P01 TRAS, CLERK OF G 1 RCU I T GOl~2T
~ •
~ ST. ~.UG I E GOUNTY, FL ~ oA -
5 ' ' ,
~ BY'
. EPUTY LERK '
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~ , BCOr. JOc7 ~ACE 1•~ -
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