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Declaration of Domic~ie and C e p
4bi458'7
TO THE CLERK OF THE CIRCUIT COURT,
- ST. LUG I E CppNTy, FLORIDA:
This is my declaration of Domicile and Citisensbip in the State of Florida that I am filing this day in accordance. and in
conformit~? with Section 222.17. Florida/~S~^tatutea.
I was formerly a legal resident of lA an I ~1 m
~ a S _ ~
~ i o and I
lCyt~l IStsta)
resided at ~ . However. I have changed my domic~7e to
1 aad NamDK)
and am and have been a bona fide resident of the State of Florida since 3 ~ S~ ~y ~
~_~i-~7 ,19J!
- and I reside at I ~ a ~ - ~tiT~r P ~ ~
(StrMt aid Numbr)
. e ~ C P~ _ ST . L UG I E County, Florida, -
(C~tyl
and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State of Florida. i
IF FOR THE PURPOSE OF ENROLItNG IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NANESS
'r'9 h~'i - I il~
57-1U~lE LGI:YlY.fl.A.
ROGER pUiTRAS
CLERK C~1;CUII C7U;'.i
46458'7
I FURTHER CERTIFY that I wdl register at my local address when the registration hooka reopen. and comply with aU
other requirements of s legal resident of this State.
I FUR R CERTIFY that I have no intention to return tom former domicile. and I intend to remain in
U C 1 E _ County.
IC+cyl
Florida, permanenLi;.
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Sworn to and subscribes before me this day of
ROGER PO I TRAS. CLERK OF C 1 RCU I T GOl~2T
ST . LUG 1 E COUNTY, f LOR 1 DA ~ ,
EPUTY IERK ~ -
a~~3~9 P~Ei65~i _
1 ~ r
AGO Form 71 T2