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Declaration of Domicile and Citizenship
4'7549 _
T8 THE CLERI? OF THE C~L'IT CiZL'RT.
ST. L UC 1 E OoUI~'!'Y~ FLORIDA: - ~ .
Thb b mT declaration of Domicile and Citisensbip in the State at Florida tbst I am ~ thb da,T in aooordanoe. aad in
eonformky with Section 222.17. Florida Statutes.
I was former a legal resident at ~ and I
18taai
resided at ~ However. I have changed m,T donniciie to
18tswt aaa N
and am and have been a bona Sde resident of the State at Florida sine ~ 3 ~ dyr of
_/Lo--e~-P-7~t.-~iKit_.~' ~ ~ G~ ~c-~-yc j
,19~~ and I reside at ~ . L ~ ~ ~
l8t~tad>Vosbar)
f~i~t.. ~ r.Gt
e..r ST . LUG 1 E countT. Florida,
lave
and this statement b to be taken as m,~? declaration of citiaeaship. aetnal legal residence and domidle in the State of Florida.
If FOR THE PURPOSE OP ENROLLING IF fOR HOMESTEAD PURPOSES
CNiLDREN IN SCHOOL, PLEASE STATE PLEASE CNEZKL
TNEIR NAMES.
190 f E6 -7 PM ~ 57
pit.EO RIiC RECTYRtFIA
S a06ER
P~OItRAS
CLERK CIRCUIt C011f1j
RECQRB ?~ERtf t~~
4'x'5498
I FURTHER CERTIFY that I w~71 register at mT loin address when the registration books reopen. and oompZj with all
' other requirements of a legal residenrt at this State.
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I FUAZ'HER CER1'Ii!R that I have no intention to return tom loaner damic~7e. and I intend to remain in
U C 1 E ~ ~ Count.
IC1t71
~ Florida, permanend;
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a. ~(3Ut'jTy
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~ Sworn to and sn ~ before me this daT of ~ ~`S
• i .
. A.D.18
i
ROGER P01 TRAS. GLERK OF G IRCUt T COtdf2T
~ ST. LUG 1 E COUNTY, f LOR t OA
•
BY: -
~ EPUTY LERK -
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