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Declaration of Domicile and Cit~zensh~p
482558
TO THE CLERK OF THE CIRCUIT COURT. .
ST. lUG 1 E OOUIVTY. FIARIDA: -
This is nU? declaration of DomicDs and Citizenship in tbs State of Florida the I am ~ this day in accordance. and in
conformity with Section 222.17. Florida Statutes. / ~
I was forme s legal resident of ,7 yam, ~ ~~-r ~ I .
~ lawl
resided at S~ G~-41.~N S ~ _ However. I have changed m, domicile to
18trNt aad Nus~~r)
and am and have been a bona fide resident of the State of Florida since A~ S dU ~
~c~?-~ .19~.. and I reside at f~,3 ~ z S - r Yyln c~ S
(ea.a..a Naob.r)
lD~ l~ ~ ` ~ G i~ - ST. LUG I E qty, tea,
lacyl
and this statement is to be taken as my declaration of citizenship. actual legal residence and domidle in the State aI Fleeida.
" li FOR THE PURPOSE O~ ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
r
~R i o ~ 2 os
ST 1. ~ ~~QQ~~~~~.
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M.EAh CwCtNT !
~lWRS VERIFI£O
_ ~~~I~Ci55$
I
I FI7RTHER CERTIFY that I ~ register st my local address when the registration books reopen. and comply with all
f other requirements of a legal resident of this S4te. _
I FURTHER CERTIFY that I have ao intention to return tom fo~rrmer domicile. and I intend to remain in
_ ~ ~ U C 1 E County.
1(Sty)
Fbrida. permanenci; .
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- sworn to and aubscnbea before me this / d a:y of P ~ 2- r S/- l ~t ~ ~ i . ~/N
A.D. lA~,.
ROGER POI7RAS, CLERK OF CIRCUIT COt~tT .
ST. UGIE COUNTY, FLORIDA - _
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BY: ti'~,`l~o,, ~
EPUTY RK
l~R c~
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