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Declaration of Domicile and Citizenship
4'71636
TO THE CLERK OF TAE CIIiCU1T COURT.
ST. LUG 1 E OOUN'1`Y. FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am ft7ing this day in accordance. and in
conformity with Section 222.17. Florida statutes. I
. ~ ~
I wsa forme a kgalresident of and I
. ICltr) l8tatel
resided at Z ~ 3 / . However. I have changed my domic~7e to
1 Nos~l 4
and am and have been a bona fide resident of the Stats of Fbrida since ~ ~ ~y of
19.~,~. and I reside at 7 ~ ~-,K ~ ~
l8tiwt sad Naafi
_ ~ ST . l UG I E County, Florida.
tC~l
and this statement is to be taken as my declaration of citisenship. actual legal residence and domicile in the State of Flacida.
IF FOR THE PURPOSE OF ENROt.LING IF FOR HOMESTEAD PURPOSES
CHILDREN IN SCHOOt., PLEASE STATE PLEASE CHECK:
THEIR NAMES:
1980 JAN -7 AN i~ 34
FIlEO AID FECOe~0E0
ST.lUC1E COUNTY.F~A.
e~nf-s nn.Te •
{\VfJf~fff V/ff\MJ
CLERK CIRCUIT COURT , ~
RECORD YEPlflEO______~
4'71636
i
I F[JRTAEB CERTIFY~that I w~71 register at my local address when the registration books reopen. and comply with all
j other requirements of s legal resident of this State.
I hKt I ha a no iaf+ention to return tom former domicile. and I intend to amain in
U C 1 E _ County.
ICdy
i Florida. permaaenti; .
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Sworn to and subscn'bed before me this ~ day of _
~ r. O -
~ ~4N U a Q~ , A.D.19~:
R ER P01 TRAS CLERK OF G IRGUI f COC~tT
OG
ST. LUG I E COUNTY, F<_OR t DA
EPUTY LERK
gooK323 PacE 874 r