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Declaration of Domicile and Citizenshi •
p
480532
TO THE CLERK OF THE CIRCUIT COURT.
ST . L UC 1 E COVrIT~r, FLORIDA:
This is my declaration of Domidle and Citiuaship in the State of Florida that I am Sling this dq in accordance. and in
conformity with Section 222.17. Florida Statute--s.~~----
Iwas formed a legal resident of tel.-l/L,r~ ~ ~d I
(City) Sew)
resided at ~ "l ~ Namtwl _ However, T have changed my domie~7e to
and am and have been a bona Sde resident oI the State of Fbrida since /YI/JU day of .
- 19~ and beside at -
~ (BhMt and NumD~tl
ST. LUC 1 E ~h,,
tC14
and this statement is to be taken as a4y declaration of citittnship. actual legal residence abd domip7e is the State of Florida.
'w 1F FOR- THE PURPOSE OF ENROt.I.ING ~F FOR HOMESTEAD PURPOSES,
CHIIOREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NANESS
~ 1980 MAR 24 Ali S2
F ~9'~'~~HCpp~~~tc~~rw a
~ 08ERtPQITJLtS d.
ERK CIRCWT`~~q~-~-•--
RCL'fRp VERIFtE~J~
4805?3rZ .
I FURTHER CERTIFY that I wtll register at my Local address when the registration books reopen. and comply with aU
other requirements of a kgil resident of this State.
I FUR1ZiER CER1'IF'Y thst I have ao intentioa to return to mY former domiede. and I mend to remain in
g. U C I E ~ty~
(City) - •
Florida.• permanenLi~ .
~ _ _ le
Sworn to and subscn'bed before me this day of .
" A.D. l~r,
ROGER POITRAS. CLERK OF CIRCUI T COt~tT
ST. lUG1E COUNTY, FtORiDA
BY: .
EPUTY t.ERK .
B~ JrL.O PAGE ~ -
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