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Declaration of Domicile and C~iizenship
TO THE CLERK OF THE CIItCU1T OOURT.
S~-. LUC 1 E _ COUN'!'Y. FLORIDA:
Tbis is a~ decLration e[ Domide and Citizenship is the S4te o~i Florida that I am flinj this da, is accordance. and is ]
o~nlazmitF with Section 2?2.1T. Z'7orida Sbtutes. i
6 ~ ~v and I
I was t~ a legal resident. d
1~~1
resided at O Rowever. I have changed mT domica~e to
1 and Hmabar!
and am and have been a bona Sde resident d the State d Florida since • ds7 d
19~.. and I reside u OQ
18v..it asd No.absl
' ~ ST . l UG i E Count, Flosida. _
tc.+~r~
. and this statement b to be taken as ~ declaration d citizenship. actual legal residence and domiale in the State d Florida.
IF FOR THE PURPOSE Oi ENRO!lING IF FOR HOMESTEAD PURPOSES,
CHIlOREN IN SCHOOIa PLEASE STATE PLEASE CHECK:
THEIR NAMES: ~
~~-t~~
Ism- ~Cw?.r~E~tiG
~979auG22 ~4
FILED A D~~RECTTORDEp
• S RL~R PO1TRi4S A~ {
CLERK CIRCWT COURT t
RECORD VERlf 1Efl,_,_
c•
I FURTHER CERTg'Y that I w~ register st mT local address when the registration books reopen. and ~mPl7 with aD
t
other regnisements d a legal resided d this State.
CERTIFY that I have no intention to retarn to m? former domicile. and I intend to remain in
I FURTHER v C~ E CountJ.
.r - -
i _ ICit~)
t Florida. permanemi;.
~j tAdBe...l
Sworn to and sobsaibed before me this daT oI ~ L ~ ~ ~
• A.D.IS-.. ~ _ .
_ .79 ,
R G ERK OF' CiRGU1T GOURT hG~~NTy
ST. LUG 1 E GOt~tTY, FLOR 1 W1 c~ ~ _
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