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44i'7043 -
TO THE CLERK OF THE CIRCUIT COURT,
S~'~. L UG I E COUNTY. FLORIDA: .
~ 4'his is mY decLration of Domicile and Citiuasbip is the State of Florida that I am fling this dad in aecordanoe. and in
confortnit~ with Seetioa 7?2.1?, Florida Statutes. ~ -
V - I was formerl a legal resident of c/,e4~ag~ _ ~XGJ .S and 1
l(xt~) lStaW
resided at ~~1 Z ~V/.~C~ SZ~ ~ S D ~ However, I have changed m~ domiule to
- (Street sad Numbs) i
and am and have been a bona Sde resident of the State of Florida since ~`3 dal ~
A
l' ~'O ~".e _ 19 ~~1- and I reside at ~~e ~G~//G ~G~,Q~ ~ ~~8 ~O~~D`1in
(Street sad Namber)
• ~Z /~i~.QL' C• ST. LUG 1 E CountT. Florida. _
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and this statement is to be taken as m~ dec]aration of otisenship, actual legal residence and dotnia7e in the State of Florida.
t
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOLr -PLEASE STATE P'tEASE CHECK:
THEIR NAMES:
t
fiLEO At;t1 h~ G~~~.Ci u t
ST.IUCIE GOiJMTY.Ft A.
ROGER P017RAS
CLERK CIRCUIT f`!}ni
4'7043
i
I FURTHER CERTIFY that I vvi7) register at mT local address When the registration books reopen, and oomph with aD
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to mi former domiu'le. and I Intend to remain in t
j T . t_ v
`r- ~ County,
_ 1(Str)
I
Florida. permaneati;.
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(Addrs.)
Sworn to and mbsrn'bed before me this ~3 dad oi• O" ~ e~ ~~Q • 33 Hsu
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. A.D.19: 79 ~
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R POI AS CLERK OF G f RGUI T COURT
OGER
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ST. lUG I E COUNTY, FLOR 1 OA •
- - - .
BY: ~
EPUTY LERK n><~~~ • •
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