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Declaration of Domicile and Citizenship ~f ~
483.62
TO THE CLERK OF THE CIItCUIT CQURT, .
ST. LUG 1 E CpUNTY~ ~,pg~A; ;
This b n0.y decLratioo of Domidis and Citisenship in the Stats of Fleeida that I am Slim this day in aooordanoe. and in
conformity with Section 222.1T. Forida Statutes.
I was f~ s legal resident of G t3 i2 N W L Z' S N t G H~ 1 ~ and I
((~tt~l 18tata~
resided at / S CJ'y A t2 1 < ~ , _ However. I have changed ~ domidle to
1&raat asd Ne~bar)
and am and have been a bona Sde resided of the State of Forida since 1 u N L 15 1 ~ day of
G - ~ ~ 19
~ and I reside at 8 ~ 0 J S . 1 Nl~ I !U ~ 1 U L R ?7R . ~ .
'052 r P. t= R C ~ ~ ST. LUG I Eeawc.eaHoe,>~
County. Florida.
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and this statement is to bs taken as my declaration of citizenship. actual legal residence and domiole in the Scats d Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILOREH IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
T
~f980 APR 16 All ~ 53
9LERIC CIRCUf~1N~~
gCiARt! Y[RIFQU_
- 43162
I FIJitTHER CERTIFY that I wi71 register at my local address when the registration boob reopen. and comply with aU
other requinmeuts of a legal resident ~ this State.
I F[JRTHEA CER17>:R that I have m intention to return to my former domicSe. and I intend to remain in
5~ _ L U C I E C~uDty,
s ¦ e ~-~-1 C... e d
IRty)
_ Florida. permanencl,•.
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,~I ` ..G~,J~,``~t 8(, O ~ Mama)
S. /NU Sri ~IUC-R y>R,l vi
Swan to and snbscn'bed before me this day of ~~2 «i ~ R C L ~ L ~ ,
A.D.1$_,~...~
ROGER POI TRASH CLERK OF G IRCUI T COt~RT
ST. LUG 1 E COUNTY, f LOR 1 OA
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EPUTY LERK '