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Declaration of Domicile and Citizenship
4455`7
TO THE CLERK OF THE CIRCUIT COURT
ST . L UC I E COUNTY, FLORIDA: .
This is my declaration of Domicile and Citizenship is the State of Florida that I am filing this day in acoordancd. and in
conformity with Section 222.17. Florida Statutes.
I was formerl~+ a Legal resident of Idi~iQKA HAR BC)I: ,NEW .R SE Y and I
ICriy) 13tat~)
resided at X11 Pi?FDi~1CLi,>: JL1TEi1TLJE . However. I have changed my domicile to
(Street and Numb)
and am and have been a bona fide resident of the State of Florida since ~,*~v_=o ,}c~-~c~ day of
,19 and I aside at ~ ~ S _ •_t~l V(>T2K S'i`
(3treet aad Number)
PO: 'T ST LUCIE ST . L UG I E County, Fbrida,
~lat~)
and-this statement is to be taken as my declaration of citizenship. actual legal residence aad domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES: "
DOREEN MARY I;OASA
JODY LYI~IN ROMA
l3~9 ~ 2 59
#M~ ~?NU ~HECGfi0E0
SE111cfE l:OUNTY.f1A.
fl~POITRIIS
~i1;CHCUR COtgtT
4455'7
I FURTHER CERTIFY that I will register at my local address when the registration 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,
ICit~) "
~ Florida, permanenci;.
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(Name)
~ I l 15' F ~y~ Y~ 12 S ! .
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S.vorn to and subscn"bed before me this~~ day of ~b s~• ~ t~C 1 z
A.D.19_ / /
s
ROGER AS, CLERK OF CIRCUIT COURT
ST. IE COUNTY, FLORIDA
• •
BY:
' ~ _ E UTY LERK _
_1197
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