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Declareion of Domicile and Citizenship
448554
TO THE CLERK OF THE CIRCUIT COURT.
ST . LUG 1 E coUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State o1 Florida that I am 61ing this day in accordance, and in
conformity with Section 222.17, Florida Statutes.
I was formerly a legal resident of `_(~-os NEN _l__nc~ ~^r,t,~ and I
. ICltyl IStaa)
resided at b ~~`r l V S 3 ~ . Nowever. I have changed my domiu7e to
• (Street and Number)
and am and have been a bona fde resident of the State of Florida since ~3T'~ day of
Z ~ . l9 7 - and I reside at ~ 29 S o ~~•R ^
(Street andNnmbez)
~a~ L"c , ~ ST. LUG I E County, Florida,
t(.l'tyl
and this statement is to be taken as my declaration o! 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:
'9 20 ~•f 3S
?,:Lc sw~ c~x~,tu
fT. LtICff tGlitiT Y. FL A.
BtlG£R POlTRa5
~K CfilCIJIT COUR~~
448554
I FURTHER CERTIFY that I will register at my local address when the registration hooka reopen, and comply with all
'i other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have oo intention to return to my loaner domict~e, and I intend to remain in
T. U C I E ,County,
¢ (City)
Florida. permanenti;. ~
E
E
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l
v ~
a cif •.!!;t v~ S TE,~ E I i/V. i(v~R.~+E2
- ~OUt11Y.F~~ ,,()Name) ~~~~~NE~
• H2~7 NRQAn~A
(Addreaal
Sw to and subsm'bed before me this ~ ~ day of cz
~ . L
~ FL
RO POI TRAS. CLERK OF G IRGUI T COURT
b
-
ST. L UG I E COUNTY, F t 1 DA
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8Y: .a
EPUTY LERK
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310 ~A~~ 29~t~ _
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