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pecE~.?~~.. - .~~i°i`i1Ct~ CE~~ze~shi~
46`7596
TO THE CLERK OF THE CIRCUIT COURT, ~ -
ST . l UG I E COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance. and in
conformity with Section 222.17, Florida Statutes.
' and 1
I was formed a legal resident of
/ ICit~l Istat.)
resided at ~ . However. I have changed my domicile to t
13trest and Numbw)
and am and have been a bona fide resid~~enyyt of the State of Florida since day of
~''U~.,.~.+'!,~- ~ y .19_L. and I reside at U.S V S
f~~ ~ 18trMt and Nomtntl
ST. LUG I E County, Florida, '
!City)
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 SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMES:
~
S F OGFR PM t elf` ~ '
CIERX CiCiU1? C'l'~~
1/ i
i'
46'7596
f
' i
f I FURTHER CERTIFY that I w~11 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 Ihave - ao intention to return to mZ former domicile, and I intend to remain in
, JT . L U C I E ,County,
ICityi -
Florida, permanents, .
f
~
. `
T
m
- tN.a,.i
q (Add»M)
~w•orn to and subscribed before me this day of
. A.D.19_ ~1
ROGER P01 TRAS. CLERK OF G IRCUI T COURT
ST. LUGIE COUNTY, FLORIDA - •
BY:
EPUTY I.ERK
e~~~321 ~a>;E 3?06