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Declaration of Domicile and Citizenship
• ~ 4'71232
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG i E COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this dal in accordance. and is
rnntormity with Section 22Z.1T. Florida Statutes.
I was tormerl a legal resident of ~'y
% ~~~-%'-}n- and I
(City) tstacl
resided at ~ `»/y f~ ~z~• ~ - However. I have changed my domiede to t
(street and Numl~.r) f
and am and have been a bona tide resident of the State of Florida since - day of
r
~~~4 a
_ 19_? ~ , and I reside at a "
tS and Number)
~ ~G,,,~~ ~ ~ L t ~ ST . LUG I E County. Florid,.
tcxcy)
and this statement is to be taken as my declaration of eitizewhip. attune legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES
CHtLOREN IM SCHOOL., PLEASE STATE PLEASE CHECKS
THEIR NAMES:
~ /J ~
{
_ ~ . , -mot' 1~~ ~ X919 DEC 3 t i'~ 2~ 4 7 ~
_ ,
- lir.~- -r FIL~~E~UD A 0 PECORi)EO
S NOGE~
P017RAS~~
CLERK CIRCUIT COURT
- RECORD VERIFIE[!~____-.~~_
j 4'71232
I FURTHER CERTIFY that I will register at my local address when the registration books reopen. and comply with a@
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.
Cit~T
Florida, permanence; .
t
GU,UNl ? ~~t ~l~~ ~~z LLB
O'
'lc~E ~C~:IIY. E~ tAddraaa) _
Sworn to and sub fore me this 3~ day of 2~ ~
.
. A.D.19!
ROGER P01 TRAS. GIERK OF G IRGUI T COURT
ST. LUGIE COUNTY, F>_ORtOA
BY : ~ . g~323 PEE 225
EPUTY LERK
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