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4Ei2543 ~
Declaration of Domicile and Citizenshi
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TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG I E COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance. and in
contormit~ with Section 222.1?. Florida Statutes. ~ r
I eras formed' a legal resident of G " L~/r/~ G''UTC/ and I
ICit) t8tat~)
resided at ~a1.~~1j11,r~_~,~1 S . However. I have changed my domicile to
tstn..t.ad Nme.r?
and am and have been a bona fide resident of the State of Florida since / day of
l
.19~, and I reaida at / 1~2.~~/ c P~~~
(Stew( sad N
' ~ ST. LUGIE
County. Fbrida,
1(Xty)
and this statement is to be taken as my dec]aration of citizenship.:dual 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. /i
42543
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f~GEC~ anc ~~cu~:,;:
StLU~IE CGUYTY. F ~ n
~+0 ER POfTRA~:
CLERK CIFCUIT CG~~CT
I FURTHER CERTIFY that I wt71 register at my local address when the registration books nwpen, and comply with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return tom former domitx7e. and I intend to remain in
_ U C 1 E ~ qty,
(City)
Florida. permanenti, .
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p abseribed before me this day of i-~ ~
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ROGER P01 TRAS. CLERK OF G IRGUI T COURT
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ST . L UC ! E COUNTY, f LOR OA - _
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BY: - - _ _ ~
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