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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: r
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This is m7 deelar:tion of Domicile and Citizenship in the State of Florida that I am filing this day is accordance. and in
conformity with Section 222.1, Florida Statutes. ~
I was formerly a legal resident of ~ !y "~7-? /yw Yo ~ and I _
(CS~r) IStat~
resided at 1~6Z ~Q 3 S'r _ However. I have changed my domicile to
(Street sad Number) r~,~
and am and have been a boas fide resident of the State of Florida since ~t T • /Gt~v .day of
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f .19~ and I reside at ~~d~ ~p~ h'- ~T~ ~ ~ s~C~._
(t3treet sad Namber)
ST . LUG 1 E Count, Florida,
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and this statement is to be taken u my declaration of citizenship. actual legal residence and domia'le in the State of Florida.
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IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
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FI~LEO A40 RECGO~
gT LUC1 CPOtONI~~ YA
199 J~Jy 18 W4 ~ 39 CLERK clRCwT C T
RECORD VERiFiEp
FILED !ht' hECOtWEO
_ .LtlCt CO~~1Y.fLA.
R~-~.t~.~d . POITC A5T
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I FURTHER CERTII; Y that I X11 register at my local address when the registntioa books reopen, and comply wstb i1)
other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that. I have no inttatioa to return to my former domicile. and I intend to remain in j
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r. _ T. U C 1 E .County. t
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g~ Florida. permanents; . -
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S•oorn to and snbscn'bed before tae this day of f~~c.. .33 ~
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~ - ROGER P01 TRAS, CLERK OF G IRGUI T COURT
ST. LUGIE COUNTY, fLORtOA '
BY: ~~nr~ AC
F ~E P UT Y e_
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