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Declaration of Domicile and Citizenshi
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4'72805.
TO THE CLERK OF THE CIItCU1T COURT.
ST= LUG 1 E COUNTY ~,Og~A;
Thfs is m,T deeLratton of Domia7e and Citissnship in the State of Florida that I am Sling this dy in aoooe~danoe. and is
coatormit~ with Section 222.1T. Florida ~St)atutes. n
I was former a legal resident of .0 1,'~~ ~ ~ ~ A,'Q '~`f 1 ~ 1 1n r 't'i ~ l _ ~ c ~ ~ ~n Q. and I~ .
resided at u ~ /~`e R/ ~ ~ $owever. I have changed my domiRS7e to
iS~..t.od N -
and am and have been a bona tide resident o[ the State od Fbrida since ~ ~ ds,T of
29~ sod I reside at ~ y~Q Ci) N L) f 1 t> ~ '
(8ttwt sad Nsmb~el
ST. LUG I E Couaty~ -
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and this s4tement is to be taken a' my declaration of citizenship. actual legal residence and domicile is the State a[ Florida.
IF POR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES
CHILDREN tN SCHOOLa PLEASE STATE PLEASE CHECKS
THEIR NAMES:
Nr~ ~
_ - 1950 JAN t 6 pK O>;
`3 ST
lUC1E
C Rt TY FIA.
- _ ROGER P~7RAS
CLERK CIRCUIT CO
' RECORR ~'ERIftE!3__~~,~.
- - ~ 4'72805
I F[)RTHER CER1'ffY 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 FURTHER CERTIFY that I have no intention to return tom former domicile. and I intend to remain in
U C 1 E ,County.
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Florids. permanenu; .
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Sworn to and subsrn'bed before me this day of t' ~ ~ t?' ~j~ 1 u ~`~-J
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A.D.19 V~ .S 3 y S ~ ~
PO I TRAS ERK OF C I GU I T COt~tT ~ V I V r 4
ST UC 1 E COUNTY, Fi.lJR 7 DA •
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EPUTY LERK
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