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Declaration of Domicile and Citizenshi
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46n166
TO THE CLERK OF THE CIRCUIT COURT.
ST . L UC 1 E COU~Y, FIARIDA:
This is my declaration of Domicile and Citireasbip in the State of Fbrida that I sm filing thin day le accordance. and i~
conformity with Section 222.1T. Florida Statlutes.
'I was formerly a legal resident of f ` ~ /.G' if/ „~/'_~%T
r1 r and I
lGtit7t 1&ata)
resided at ~ ~ C(~ iy1.3H f/4'G / . However, I have changed my domicile to ~
(3treet and Number) ~
i ~
and am and have been a bona fide resident of the State of Florida since _ ~ - - ~-2 ~0 7 day of
.19 _ and I reside at ~ I'~ S~ l ~ ~,[/,~/QT / F r YG c
ISt»et asd Hnmbrl
,~6 ~ f" ~ f- L U , ST . L UG I E County. Fbrida.
l(5~71
and this statement is to 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 SCHOOt., PLEASE STATE PLEASE CHECK:
THEIR NAMES:
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~~19 0~; 29 s~ 43
1zor;eR Posrr•.,;s
CLERK CfR~:tt' G~y~3;
• 464166
I FURTHER CERTIFY that I wdl register at 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 tom former domicile. and I intend to remain in
_ T~ U C 1 E County.
ICit~)
Florida. permaaenci, . z
1
i
~J r f' .
LC e ~i
Sworn to a~at~eribed
before me this a ~ day of ~ rt ~ ~ l ~ ~ ~ ~ .
Oc~aht ~ A.D.19_ 79 C?ud•`f~l , Qo~c ~f $rczg~ve>
ROGER PO I TRAS, CLERK OF CIRCUIT COURT 5
ST. LUGIE COUNTY, FLORIDA -
' - ~
l
BY.
EPUTY LERK
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