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Declaration of Domicile and Citizenship - ~
4265 ~ , .
TO THE CLERK OF THE CIRCUIT COURT,
ST. LUG 1 E ~ -COUNTY. FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing thii day in accordance. and in
conformity with Section 222.17. Florida Statutes.
I was formerly a legs) resident of and I
tCit71 (Stara
resided at G r However. I have changed my domicile to
(Street and Number)
and am and have been a bona fide resident of the State of Florida since ~ 'day of
N ~
19- _ and I reside at
t'?• ~Gf - ST. LUG I E~~N~~l
County, Fbrida.
tt~e~l
and this statement is to be taken as my declaration 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 NAMESI
I FURTHER CERTIFY that I wt71 register at my local address when the registration books reopen, and comply witb iU
other requirements of a legal resident of this State.
f I FURTHER CERTIFY that I have no intention to retnra to my former domicile, and I intend to remain in
- T U C E County.
(CSt~I .
Florida. permanenti; .
.919 J' ~ s P!~ 2~ ~ z
5
FILED Ah0 FECf~RDEO
S ROGER
PQITRA~A'
s _ _ CLERK CIRCUR C
a RiCORD YERIFtEp____ ~
G 4485
per,,. 1 (Addraa)
S•vorn to and snbsm'bed before me this ~ da of ~ , ~S~
_ y _
s ' ':r si 1.
ROGER POI TRAS, CLERK OF G lRGUI T COURT - Y.~~
ST. LUG I E COUNTY, f LOR 1 OA - _ ' " ~ ~ ,
EPUTY K -
F eo~K~310 ~a~E2540 -
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