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Declaration of Domicile and Citizenship
482'735
TO THE CLERK OF TAE CIRCUIT COURT. 1
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_ ST. LUG 1 E COUi+lTY~ ~,Og~A;
Thb b ~ deelaratIon of Domidls and CZtizsnship io the State of Florida that I am SNna this dy in accordance. and in
eootcrmity with Section 222.17. Florida Stttutes.
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I was fo~ a bgal resident of - 1<J E' A \ / c" ~ ~ ~ ~ and I
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resided at a 5~ ~ ~ -However. I Gave changed cqy domii3k to
and am and have been a bona ifde resident oSthe State of F7arida since ~ ~ ~ : ~ • ~ ~ ~ n dy of
h~ I ~ - -19 ~ snd I reside at ~ ~7
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letre~t Hrebr)
~D ~ tt C i ~ ST. LUG 1 E
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and this statement b to be taken as n4y declaration of citizenship. acqul legal reaideaos and domicils in the State d Florida.
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" If fOR THE PURPOSE OP ENROLLING IF FOR; HOMESTEAD PURPOSES,
CNII.OREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
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Cif
glMllitKR1?!~
48235
I F'[JRTHER CERTIFY that I wNl register at my local address when the regiatratian boob reopen. and comply with all
other ngnirements aY a legal resident of this State.
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I FURTRER CERTIFY that I have no intention to return tom former domip'k. and I intend to remain in
- ' ! E .County.
_ ~r ~ 1
Fbrida. permanend; .
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Swore to and sabeerribed before me this day of - ~D 't-~ 1..~~C 1 ~ (A .
- A.D. i~ ~ .
ROGER P01 TRAS. GLERK OF G IRGUI T COt~2T
. ST: LUGIE COUNTY, FLORIDA ~
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- 8Y: ' ~
EPUTY LERK
' ~ BUtIK~ PAGE r .
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