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Declaration of Domicile and Citizenship
462548
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E COUN'py~ ~,O~A;
This is my deelantion of Domieik and Citisenship in the State of Florida that I am filing this day io accordance. and in
conformit~r with Section 222,17. Florida Statutes. t
I eras fob a legal resident of _ V`t- ?-1 R 2l i~ , _,iVl 14gS . and I
(Cltyl tt3ewl
resided at ~ ~ Z 1~ EG at A ~l ~ c- ~ t . . However. I have changed my domic~7e to
(3trwt and Nuovbar) ~ T ~ ~ of
and am and have been a bona fide resident of the State of Fbrida since y
e'l' , 19 ~ q - and I reside at Z 3 ~S L- ~ ~c~ ~
tom- S ST . L UG I Et3a..c..a rl,u~ae.r1
County. Florida.
t(~t71
and this statement is to be Wren as my declaration of citisenship. actual legal residence and domicile in tbe State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOIr PLEASE STATE PLEASE CHECKt
THEIR MAMESt
~ ~ ~E.rz ~ ~ A,~1 ~~I=LL
9rg QCT ! 5 P,~ 2: p !
E-I~~~S 1 to ~ Al ~L ( FItLD ~:tit~ k'
SLLUCtf CoUYTY.fi„.
_1~~~ 1 ~ ~4 l A ~ ~~L ~ C ERII CI+ZCUtT OURT
.
46?254g
I FURTHER CERTIFY that I will register at my local address wben the registration boots reopen. and comply with aU t
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return tom former domicile. and I intend to remain in
U C I E County.
Florida. permanenci, : •
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ri i~~ ~r'• (Naa+a) i
• s~ Z 3 `dZ ~1?-at~~v ~l2 D
Sworn to and anbarn`bed before me this ~ day of ~ L - •
R ~ ER AS G ERK OF G RGUi T GOURT
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ST. LUG i E COUNTY, fLOR iD ~ . ~
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EPUTY JERK 1.4:» t
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