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Declaration of Domicile and Citizenshi • ~
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454481
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'I00 THE CLERK OF THE CIItCUIT COURT. ~
S'~. LUC i E COUNTY. FLORIDA:
This b my declaration of Domia7e sad Citizenship is Lbe State of Florid: Lhst I am fi)ia= Ibis d~ is aceordanee. and in s
conformity with Section 222.17. Florida Statutes.
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I was former a legal resident of - and I
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resided at gy ~ - However. I Iuve changed m7 domicile to
18trsst and Nnmbd
and am and have bees a bona Sde resident of the State d Florida since T- a ~ ~ - ~y d
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1~~ ~ .19~. and I reside at o~D9 S ~l
18t+~ asd j
e`Z~ • 1..,e.~ ~-~_e_J ~ ST. LUG 1 E Co~uaaty. Floa.;da. _
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sad this statement b to be taken sa my declantioa of ritizenship. actual legal rssidenoe and domicile in the State d 1:7arida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES, r
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMES.
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1919 A±'G -9 ~ ~ ~:3
FILED A!ID RECWb~EO
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RJR gRi7_ _ SA.
CLERK Ca~~
RECORD VEttIF1Efl~-
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454481
I F[1RTHER CERTII~'Y that I wtV register at my local address when the registration books reopen, and comply with all
other requirements d a legs] resident d this State.
I FURTHER CERTIFY that I have no intention to return to my former domieale. and I intend to remain in
i 1 o i T. U C I E County,
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Florida. permanents;.
NOUN ty
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sworn to and snbaaibed before me thb day of
R A CL K OF CIRCUIT COURT
ST. LUG 1 E COUNTY, ftOR 1 OA -
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SY S
' PU LERK '
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- s~3i4 P~ 934 ~ = ~
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