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Declaration .of Domicile and Citizenship
.4'71858 .
TO THE CLERK OF THE CiIiCCUI'r COURT.
ST. LUG 1 E COUNTY. FLORIDA:
This is my declaratioa of Domicils and Citimnship is the State of Florida flat I am Sting this day in accordance. and in
conformity with Section 222.17. Fbrida Statutes.
I was former a legal resident of Wf .fy ~ ~ ~ Y~ 4~ ~Fk/ yo R ~ I
ICn7) lBtaW
resided at 3 3 f'AR i('~2 g~,E - However. I have changed aqr domir~7e to
(8trMt gad Namb~d .
and am and have been a bona fide resident of the State of Florida since r ~_.r / = f T day of
c-~ .4N UL2 /t J' ,19~. and I reside at 3 Q (~-~'¢!Vd ~ L~lST~4 L~/A Y
(Strwt sect Nom~r)
/soar sr L v c ~ f , ~ ST . L UG I E County Florida.
«xcl
and this statement is to be taken ra my deeLration of citir~eaship. actual legal residence and domieSe in the State at F7oeida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
_ t
1980 JAN -8 AK i~ 30
. FILED AHD AECORDkO
ST.Lt~IE COIRITY.FIA.
Ro~~aER POITRAS
CLERK CIRCUR C~
RECOP,D VEP.[Ftr~
4`71858
I 1•'LJRTHEB CERTIFY that I ~ register at my local address when the registration books reopen, and comply with all
other requirements of a legal resident of this State.
i
I FURTHER CERTIFY that I have no intention to return to my tormer~
'~e. and I intead to remnaYin_ in
_ J 1 ~ L V 4 1 G ,County
~ (City) _
Florida. permanenci; .
F
.zi~i~ililSll;
ice', ~_!31`r
~ ~ i A v
~ ~ 1
(N~)
r/:: i,~t 11t1~~~~~`` (Adder) '
Sworn to and subscn'bed before me this ~ day of ~ivl . ~G . ~-u~..~e~-
•
A.D.19~ `.C Nt
y
ER POITR CLERK OF CIRGUI T COCdRT
ST. LUG I E COUNTY, f LOR 1 DA
~ BY: ~v--''~
EPUTY LERK ''rr~ cc~ p
} ~ - BtfOK ~N:.J P~Cf ~05
ern r,...... ~ ~