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Declaration of Domicile and Citizenship
463595
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E COUNTY, FLORIDA:
This is my declaration of Domicile and (titiunship in the State of Florida that I am filing this day in accordance. and in
conformit; with Section 222.17, Florida Statutes.
I was formerly a legal resident of FEliI'9TG~ /'?I.s~,~~(.µ~//'
sad I
1(.tityl ~su>.el
resided at .3 y03 %~J.J~'~p u' h '~n • . Ho.vever. I have changed my domicile to
(Straat and Number)
and am and have been a bona fide resident of the State of Florida since 2 Z ~
a day of
R f~ ,19~, and I reside at G G~GE~.v y~~c~~' . , 3//.3,
(StraataedNambKl -
~iF.c'~ ~ - _ ST . L UG I E County, Florida,
~a~~?
and this statement is Lo be taken as my declaration of citizenship. actual 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 CHECKS f'i%'~
THEIR NAMESS
X979 ACT 24 2~ OZ
f iLEO ANC Fr Cir.'~li i~
SLLUCIE C~UNTY.fL,i.
ROGER POtTfrAS -
CLERK C1P.L'JtT
463595
I FURTHER CERTIFY that I wdl register at my k>'cal 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 tom former domicile. and I intend to remain in
_ _ _ _ _ U C 1 E County.
' t 71
Florida. permanenti; .
rj~ ~G~
-
_ ~ (Addraw)
S.vorn to and snbsrn'bed before me this ~ day of . f /f~'~,E /cL /'4 .
~ , A.D.19
: ~1
ROGER PO I TRAS. CLERK OF G I RCU I T LOUR T
ST. LUGIE COUNTY, FLORIDA "
EPUTY LERK •
~lx 319 Pd~E 14~ ~ . , ~
aQ~x Afn Fr:-m 71 ?2