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. Declaration of Domicile and Citizenship
4'71546
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG I E COVriTY, FLORIDA:
This i, my declaration of Domicile and Citizenship in the Stats of Florida that I am filing this day in aooo:danos. and is
conformity with Section 222.17, Florida Statutes. .
1
I was forme a legal resident of C O L ~ ~~%v~-- D~ aai I
~-~it (stae•1 ~
y ~ I Q c h i4 ~2 ~ I ~F ~ ~ _ However. I have changed nq domia7e to f
resided at ~
(Stet aad Nsmbrl
and am and have been a bona fide resident of the State of Florids since ~ ~ ~ dSy ~
C ~~L'E/~ ,19 and I reside at O ~ S VlJ
~b~ ~
J , L- c~ r_ ? E _ ST. LUG 1 E ~„nty, g~a,
tCttyl
and this statement is to betaken as my declaration of citizenship. actual legal residence and domia7s in the State of Florida.
IF FOR THE PURPOSE OP ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL., PLEASE STATE PLEASE CHECK:
' THEIR NAMES:
19~ JOIN -4 dK I1~ I S
g~c
r~ca-u~o
i ~OITRA~w.
' Q,I~ CIRCUR
- g90iR1! V'ER1F1fD
4'71546
I F'URTIIER CERTIFY that I will 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
c U C I E - County.
Cdl) .
~ Fbrida, permanend; .
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Sworn to an before me this ~ day of ~ ~ ~ ~ f ~ y~
. ~ A,~U U n- R ~ , A.D.19~_.
ROGER POiTRAS. CLERK OF GIRGUI T COC~2T
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ST. LUG I E COUNTY, FL.OR 1 DA
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EPUTY LERK -
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