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Declaration of Domicile and Citizenship
TO THE CLERK OF THE CIRCUIT COURT. 4'~~~
ST. LUC 1 E COUNTY, FLORIDA:
Tbis i, my deeLrstion of Domicile and Citizenship in the State of Florida that I am filing this day in accordance, and in
conformity with Section 222.1T, Florida Statutes.
I was tormerlr a legal resident of ~O ~ ~ ~f] O and I
ICit~l !state)
resided at _ 3 77O N ? I ~ p~` l)r1 However. I have changed my domicile to
• (3treet and Number! ;
and am and have been a boas fide resident of the State of Florida since 5,~ C Q ?y day ~
C - ~ 19 ~ ~ and I reside at 15b ~ ~ G r t ~ n ~
tstr+et and Number)
~c,r 5~ . L~ C ? e- ~ ST. LUG I E County. Florida.
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and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State o[ Florida.
If FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES
CHILDREN IN SCHOOLS PLEASE STATE PLEASE CHECK:
THEIR NAMES:
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4'71.195
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CIRCUIY COURT
REC1I10 VERtiIEO-------
I FURTHER CERTIFY that I wi71 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 to my. former domicile. and I intend to remain in
. T. U C I E County.
lCit~) -
Florida, permaaenti; .
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Sworn to and suiy'li~eti before me this ~ da_-
y of _ PQ r `
~ . 1 C ~ ? , ~ l - ~.1 yS 2 ,
9 _ ;
1Jr~Ct?M A.D.19~ .
ROGER POI TRAS. CLERK OF CIRCUIT COURT
ST. LUGiE COUNTY, FLOR1dA
BY:
EPUTY LERK
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