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Declaration of Domicile and C~tiienship
x'78909
TO THE CLERK OF THE CIRCUIT COURT.
ST . L UG I E COUNTY, FLORIDA:
This is my declaration of Domicile sad Citizenship is the State of Florida that I am ftling this day in aooordanoe. and in
conformity with Section 222.i?. Fbrida Statutes.
I was fob a legal resident of ~ ~.r b on ~ a ~ e- ~ i I 1 n ~ [ s and I
II-- ((till) l9tete)
resided at ~T ~ . However. I have changed my domiede to
(Street eadNum~l
and am and have been a bona fide resident of the State os Florida since o? .S day of
i
19~.L~ and I reside at ~ ~ ~ ~`t n ~ i ll ft. TT Y P~
gad Nnmb.r)
_ . ~i ~P_ C' ~:P . ST . LUG 1 E County. Fbrida.
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and this statement is to be taken as my declaration of dtizenship, actual legal residence and domic~7e in the State of Florida.
"~If FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMESS
a-f--h ~ ee.n ~ . ~l o v P r-
_ _ X80 MAR i l lei ~ t g
~ 1a ~f 0
`A.
- ~ Y
VERN(EA
4'78909
I FURTHER CERTIFY that I wtll register at my local address wbea the registriti~ books reopen. and comply with aD
other regnirements of a legal resident of this State.
I Fi1R1~IER CERTIFY that I have no intention to return tom former domict7e. and I intend to remain in
U C 1 E .County.
(Cap) _
Florida, permanent(; .
; /
~ " - -
~ ~
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••yd
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~ ~ , ~ (AddreMl
sworn to and subsen"bed before me this say of
~CVl G"t/l L/~ _ ~ A.D. 2$~__._
ROGER P01 TRAS, GLERK OF G 1 RGU 1 T COt~tT
ST UGIE COUNTY, fLOR1DA
BY: -
EPUTY IERK
~~~~327 P~~ 312
A(;n Farm ?l ~1'
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