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Declaration of Domicile and Citizenship
446?SS'7
TO THE CLERK OF THE CIRCUTf COURT.
ST. LUG 1 E COUNTY. FLORIDA: ,
This is mJ declaration of Domicile and Citizenship in the State of Florida that I am filing this daJ in accordance, and in
conformitJ with Section 222.17. Florida Statutes, i
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I w as formerly a legal resident of ~ Z _ and I
(City) b)
resided at ~ ~-es-~e-o . However. I have changed mJ domicde to
1 and Number) - ~..L
and am and have been a bona fide resident of the State of Florida since ~ ul daJ of
19~' . and I reside at ~ _ . L
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Number)
--~~~L.•t ~ ST . L UG I E CountJ, Florida.
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and this statement is to be taken as my dedaration of citizenship, actual legal residence and 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:
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1919 ,lllt~ -4 P~~ t2~ 48
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i~F!l~~PO
RSA.
OIE~IL pRCU1T COt~t
fiE{;dgp 1/GAtfiEO 7~ i
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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 I FURTHER CERTIFY that I have intention to return to my former domicile. and I intend to remain in
T. U C I E ~ CountJ,
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R Florida. permanenti;.
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(Addrsae)
Sworn to and subsrn'bed before me this y~ day of ~ 3 ~J U
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- ROGER PO I TRAS. CLERK OF C 1 RCU i T COURT . ~Yw......,,,
1W• L_ i-.
ST. LUG i E COUNTY, f LOR 1 DA - ~
EPUTY LE K ~ ~,s;4°~s:, 'Cti~
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