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Deciarat~on of Domicile and C~tizensh~p
463304
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 Cling this day in sooordanca. and in
conformit~? with Section 222.17. Florida Statutes. ~
I aru formed a legal resident of ° N
~
tt> Yn.~. and I
pp~~ pty) IStat~)
resided at -~~''Q„bol~4~ - . However. I have changed aUr domicile b
18te+st gad Nosbor)
and am and have been a bona fide r~eaident of the State ~ Florida since / ~y ~
( /C'~n ,fjL_/' -19~~ and I reside at ~Ol ~ ~ X~'~/n P_ ~ ~ ~ ~d - -
IStrEaat sad Nnmb~r)
r-~ S-~_ u.~ ~ _ ST. LUG I E qty, Fla,
(City)
and this statement is b be taken as my declaration of eitizeaship. actual legs! residence and domict~e in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
~2 ^ ~ /,J~b ~ r
~~~m - 22 r~::2~ G4
Fi:tC ~htrF_cWCi;.u
~ 1. LlJC.E C TY. Fl JI.
ROGER RAS
CLERK C ql~. ,
463304
I FURTHER CERTIFY that I wdl register at my local address when the registration books reopen, and comply with aU
other requirements of a legal resident of this S4te.
F
i
~ I FURTHER CERTIFY that I have no intention b return b my former domic7e. and I intend b remain in
_ U C 1 E ,County.
I IGtit,l
Florida. permanents; .
a
~ COUNT
Sworn b and subsertbed before me this ~ day of
9
A.D.1J `I/
ROGER P01 TRAS, CLERK OF G IRGUI T COURT
s
ST. LUG I E COUNTY, fLOR 10A
BY: ,
EPUTY LERK ~ ~ l
ti `