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Declaration of Domicile and Citizenship
46161
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E COUNTY. FLORIDA:
This is my declaration of IbmieDe and Citizenship in the State of Florida that I am Bing this day id accordance, and k
conformit; with Section 222.17. Florida Statutes. p ,,l
•I was formerl~? a kgai resident of 1 ~ t~~ N~ `11~U~tY1 and I
1(~t71 IStat~)
resided at ~ ~ V • 0 y~ ST ' . However. I have changed mp domide to
IStraat aed N~mb~d
and am and have been: bona fide resident of the State of Fbrida ainoe ~7 ~
.19 _ and I reside at U 5 TP~'`N~~.t l ~ P
18wat and NumDar)
i ~F-• S-~ _ L c.~ c.~,t _ ST . L UG I E Count. Florida.
«stl
and this statement is to be taken as my declaration of citizenship, sctual legal residence and domia7e in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE SPATE PLEASE CHECKt
TH,E1IR NAMES. ~L p ,,r
C ~c 1 ~ ~ ~ ~V i rTt- r ~ - 1~~ ~ 1`~l~
:,'i9 QrT 29 t,4' ~4
ST.LUCII. COli~i_Y.il:..
RCG~ft rul ~ nn5
CLERK CIRCUITQC~L'R
4~~1s1
~ I FURTHER CERTIFY that I will register at m~ local address when the registration books reopen. and rnmPIP with all
I
i other requirements of a legal resident of this State.
I FURTHER CERTIFY that _ I have no intention to return to mp former domicile. and I intend to remain in
r . L , t r ~ ~ . . a.. u ~ L .Count.
- - ~ -moo
Florida. permanensi; .
i
i
s
` . ~ . rte . ~ h~-;.t,~~t ~ F K~D~ D- L~ N(;zr~t ~
f;3 ~y TIN u
~ !-~v~
sworn to ~ v fore me this day of ~ l
~e ~ A.D. ~9
: 79 C nli L fnd o D. 8A IANs zee,
ROGER PO I TRAS. CLERK OF CIRCUIT COURT
f
ST. LUGIE COUNTY, fLORiOA ~ _ ~
BY; _
EPUTY LERK ~
63~K31y PAGE r,.~"_.