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Declaration of Domicile and Citizenship
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TO THE CLERK OF THE CIRCUIT COURT
ST. LUG i E CpUN'I'Y, ~,O~A; -
This is m7 declaration at tlamie~7e and CItizenahip is the State of Florida that I am Sling this daT in aooordance. and in
coaformitT with Section 222.17. Florida Statutes.
I was tom a legal resident of ~ !~A'f2~C S ~ and I
(G'it7) (State)
resided at ~ ~^'l ! ~ ~ ~ However. I have ch:raged actT domicde to
(8treat and NambK?
and am and have been a bona fide resident of the State of Fbrida since , r` ~ ~~w ~Oi~.T daT at
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v and Ireside st ~0 S ~ ~~s T~6 13 ~ ~ Q
(Steeat aod:Imn~t)
- ~'o Yl,~, L y C /E _ S T . LUG 1 E Count. Florida.
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and this statement is b be taken as mT declaration of citizenship. actual legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENRO!ltNG IF FOR HOMESTEAD PURPOSES,
CNIlOREN IN SCHOOL, PLEASE STATE PlEASE~CHECK:
THEIR NAMES: -
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S p,y~,~ i9~0 F~6 26 PF: 2~ i l
f~£0 ANC } tCURUt ti
S[IUCR COi1NTY.fI;~.
ROGER PQITRAS
CLERK GiZCl:IT COt1RT
4'~`T222
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I FURTHER CERTIFY that I wt71 register at m~ local address when the registration books reopen, and oomph with all
other requireme~s of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return b m former domic~7e. and I intend b remain in
U C t E . Couat~.
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Fbrida. permanents; .
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Sworn b and subsen'bed before me this ~ day of ~o.ll T f ~ ~ c !.F ~ L /d -
_ ~ . A.D.18~ e Cpl _ e- ~ c `n ~
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ROGER PO?I TRAS. CLERK OF C IRGUI ~ COtdRT
ST. LUG I E COUNTY, f LOR 1 oa - -
BY: ~ r.
PUTY lERK
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