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Declaration of Domicile and Citizenship -
4633~?8 -
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG t E oOUrITY, FIARIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in aetordance. and in
contormit; with Section 222.17. Florida Statutes.
.I was formed a legal resident of /~A~%A S C,C c-~ A _ /V
E~cl ~/E~S ~ ~ I
lC'ay) IState)
resided at ~ ~ ~ mA ~TREf T _ _ However. I have changed my domicile to
(street.aa NumbR)
and am and have been a bona fide resident of the State of Florida since ~
< ~ ~y ~
~Er~ TEiYIC~ E'L' _ _ _ 19
7
y _ and I reside at / / / L'`~ S t- r~5 ~~R . /d
l8tnaat sad Nnmber)
oJiE s ~ n! ~ ra C N ST . L UG i E County. Florida.
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and this statement is to be taken as my decoration of citittnship. actual legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SOHO-OL, PLEASE STATE PLEASE CHECKS
THEIR NANESS !v
~ 4~i3328
- 1979?-act- p. M+• 1:
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! I FURTHER CERTIFY that I will register st my local address when the registration books reopen, and comply with all
other requirements of a legal resident of this State.
~ I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain in
T. U C I E County.
lAty)
~ Florida. permanence; .
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:ir ' , ? ~ ' ~ A . ~ ~ ~ L.c.~, _~`.-mac _t~.c,c,.,~.~
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7 Q ~ (Name)T
~ Swarato
and snbsm'bed before me this ~ day of ~E l•% ~ ~ ~3 CA c~N /-L o 2 i~,~q -3 . ~
- .79
ROGER P01 TRAS, GLERK OF G i RGU 1 T GOURT ,Lee C a rz ~ s ~ N
ST. LUG I E COUNTY, FLOR 1 A E
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