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Declaration ~of Domicile and Citizenship
- 493'TT0
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUC 1 E "COUNTY. FLORIDA:-
This is my declaration of Domicile and Citiseaship in the Stato of Florida that I am filing this day in aaordance. and in
-_conformity with Section 222.17. Florida Statutes.
R
' I was formed a legal resident of ~ C~Bl/G~i4'dL~ aff~o and I ~
1(atrl IStaW
resided at ~ Ll ~~G • . However. I have changed rqy domicde to
. (Street aad Nnmbad -
and am and have been a bona fide resident of the State of Florida since day of
19 - and I reside at T ~/Q ~~D s~iiVe S e~/PCL F
. (Street and Number)
~o~T P~~,ec~ _ sT. LUC 1 E County.Florias.
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and this statement is to betaken as-my declaration of citizenship. actual legal reaidenee and. domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HONESTEAD PURPOSES
CHILDREN IN SCHOOIa PLEASE. STATE PLEASE CHECK2
THEIR NAMESS
I FURTHER CERTIFY that I will register at my local address when the registration books reopen. and comply with all
~ other requirements of a legal resident of this State. •
I FURTHER CERTIFY that I have no intention to return tom former domicile. and I intend to remain in
T. U C I E ~ ,County.
(tSl~l _
l Florida. permanenui - ; ~
. R E01 P~~~~ggqSA'
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RECORO V'i:RtF1E0._,_$.~_y
. - ~~LE~I/ GAFC.eGE
~ Sworn to and subsertbed before me thi+~ day of - ~L s D 1~.~ e_ 1 3 3 ~ ~e
~ A.D.19~_
~ R GER PO I TRAS.
CLERK OF _C i RCU i f COC~2 T - •
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ST. LUG I O:l~8yy ~ :.JR 1 UA - . -
8Y: •
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1• ' a to1983. '
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