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Declaration of Domicile and Citizenship ~
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TO THE CLERK OF THE CIRCUIT COURT. {
ST. LUG 1 E _ COUNTY, FLORIDA;
_ ,
This is my declaration of Domictle and Citizenship !n the State of Florida that I am Sling this day in accordance. and in ~
conformity with Section 222.17. Florida Statutes.
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I was formed a legal resident of -i_Ll~~,lrs~eu , ~ O and I
ICityl IStatel
resided at ~ ~ \ ~ L` ~ - However. I have changed my domicile to
(Stmt and Nambed -
and am and have been a bona fide resident of the State of Florida sincx ~~"^l 'Q day of
19~. and I reside at ~t~~n.~~~1 e
(Street and Numbed
e vC ST. LUG I E County, Florida,
t(St~l
and this statement is to be taken as my declaration of citizenship. actual legal residence and domidle in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
z
1979 JUN -4 A!~ 1~ 00
FILEO ANO Ri:Cl1R0E0
ST~L~~
POITRA~A.
- CLERK CIRCUIT COUR
RECGRO YEAIFIED
446509
' I FURTHER CERTIFY that I wtU register at my local address when the registration books reopen, and comply with all
other requirements of a legal resident of this State.
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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,
~ ICAO
Florida, permaneati;.
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. ~AR3A~~1 Bea-!_~~v[~fL
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S.oora to and subscribed before me this ` day of
y~ ROGER P01 TRAS. CLERK OF G IRGUI T COURT ~~``~V
~°~~'-''•i't':_-
ST. L UG I E COUNTY, f LOR 1 OA ;
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