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Declaration of Domicile and Citiienship ~ ~
484531
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG I E COU~y, ~,O~A;
This is my declaration of Domicils and Citiuwhip in the State of Florida that I am Sling this day in accordaaoe. and in
conformity with Section 222.1?. Fbrida Statutes.
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I was formerly a 1ega1 resident d ~ ~ ~ '1 ~ / ~ - and I
resided at ~ / T ~ ' ~ ~ ~ However. I have changed my domia7e to
(8traat and NumDaN /
and am and have been a bona fide resident of the State of Florida since ~ day of
~ lg~ and I reside at ~
t8ttwt and Nambatl
ST . L UG I E County. Florida,
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and this statement is to be ea as aU declaration ~ citizenship. actual kgal residence and domicde iu the State of Florida.
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_ IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
1 NAMESS
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t9yiQ H~ 24 ~ 52 '
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iL£11sIpRCINT C~d[NtT~
484531
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I FURTHER CERTIFY that I wRl register at my local address whoa the regiatntioa boolu reopen, sad comply with sn
other requirements o[ a kgai resident oT this State.
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I FURTHER CERTIFY thst I have no intention to return tom former domie~7e. and I intend to remain in i
U C I E , ~~y,
1(Styl {
Florida, permanenti; . #
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COUIyT c .
~l~ ~ .OG
lGCf~GUNSY~E~'~QO i
(Addraw) _ _
SWOrn to and subscribed before me thin ~ day of
A.D.19 8... o .r
ROGER Pa 1 TRAS, CLERK OF C ! RCU 1 T COtdFt T
ST. LUGIE COUNTY, FLORtOA -
BY : -
EPUTY LERK
~~328 ~~E X27 -
.AGO Firm 71-22
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