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Declaration of Domicile and Citizenshi ~
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TO THE CLERK OF THE CIRCUIT COURT.
ST . L UG I E COUNTY. FLORIDA:
This is my declaration of Domic~e 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 v. as formerly a legal resident of %?Ef/E~ /1/ ~ and I
r~ f q, (City) (State)
resided at ~-gyp/ ~flT~
,E/~{ • . However. I have changed my domica7e to
(Street and Number)
and am and have been a bona fide resident of the State of Florida since _ ~ day of
19~ and I reside at .3'0~ - ~~l ~~/y/4-/+~ C~ I •
(Street and Numbv)
~G/y -7-~ ~ ST. LUG I E County, Florida,
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and this statement is to be taken as my declaration of citizenship. actual legal residence and domicde in the State of Florids.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CH 1 LOREN 1 M SCHOOL, PLEASE STATE PLEASE CHECK: ~C
THEIR NAMES: J
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1 FURTHER CERTIFY that I wt71 register at my local address when the registration books reopen, and comply with all
~ other requirements of a legal resident of this Stan.
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,
3~ (CRy)
F Florida, permanenti;.
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Sworo to and subsrnbed before me this ~ day of ~
E
A.D.19;~/
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ROGER POI TRAS. CLERK OF G IRCUI T COURT
ST. LUG i E COUNTY, FLOR t DA -
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BY: .2~~ ..a
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• E P U T Y L E R K g0~r 309 n~~c 2569'
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