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~eclarat~on of y C~~czen,.o ~
4~9~fi~.
TO THE CLERK OF THE CIRCUIT COURT.
ST . LUG 1 E COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in aooordaaoe, and in
conformity with Section 222.17. Florida Statutes.
. C1 ~~n m c. and I
I was formerly a legal resident of t ~ G
(City) IState)
resided at S~'
~ Ja ~ l r• , ,~n c e u ~ I /E, , C iSSO)7, However. I have cbangea my domicile co
(8ttset sad t~amber)
and am and have been a bona fide resident of the State of Floridasince /tee v c ~ 1` ~ day of
~~ii
"4c,~ ~ .-N ~ e: ,19
7
I - and I reside st 1 ~y / S- t - E /lC~i~ ~-t ~Y ~2 .
- - - - (Bteaet and Number)
poi t Sf G any ST . LUG I E County, Florida.
- Idyl
and this statement is to be taken as my deeLntion of citizenship. actual legal residence and domicile in the State oaf Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES, ~ •
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK2
THEIR NAMES: ,
~~Z/'b~t'-Q ~'Q~i~ /7PSf
_ _ ?
flLEO eN~ • • ~:UEO
i . lUC=F ti' FLA.
PG :"f ~S
CLEK? ,CURT '
4 ~94~~.
i=
t
I FURTHER CERTIFY that I wt71 register at my local address wben the registration books reopen. and comply with all
of ner requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain in
~ _ , T u c County.
ICity1 -
Florida. permanenti;.
I
1
.
~
- i
• (Name)
- IAddreael
Sworn to and subscribed before me this day of
/l`J _ A.D.19_ ~ 9
i -
~ RQGER P01 TRAS. CLERK OF G IRCUI T COURT
ST. LUG I E COUNTY, FttJR 1 dA
BY : ~
EPUTY LERK ,
'~R
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