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Declaration of Domicile and Citizenship
495'78'7
TO THE CLERK OF THE CIItCUIT COURT.
ST. L UG I E COUNTY. h4.ORIDA:
.
This is my declaration os Domicile and Citizenship in the State of Florida that I am Sling this day in acoordaace. and in
ooniormity with Section 222.17. Florida Statutes.
I was fob a kgal resident os ~~5~ ~ _ ~L and I
1(~tr) leeatl
raided at ~a a-1'1 - However. I have changed my domie~e to
and am sad have been a bona Sde resident of the State ~ Fbrida since ~ ~ ~ .day of
rnlL ~ -19 nc ~ - and I nxide at ~~A 1 S 1~P 1 '~P r
IStrMt aed Namb~r)
~ ~-St, Lu c ~e. ST. LUG I E Counti. ~;d,,
ICkl)
and this statement is to be taken as my declaration ot* eitizemhip. adzes] kgal residence and domic3k in the State a[ Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES
CHILDREN IM SCNOOLr PLEASE STATE PLEASE CHECKS
THEIR NANESS
~_~c rya Qi~ n1~ ~ 13 S
1900 AIfU i I ~ ~ 20
~u~ S ~ d s~uo
- `s TY.fLA.
~SSA.~s,~ lQry?•~ ~•t-tcGt_cS D~~ CtE ~COU T
RECfiRD VCRIFICI)._ _
. ~ 495'78'7
I FURTHER CERTIFY that I w~71 register at my local address when the registration books reopen, and comply with all
other requirements of a kgal resident of this State.
I
I FiJRTHER -CERT~'Y that I love no intention to return to my former domieik. and I intend to remain in
. ~ - _ U C 1 E .County.
- ICitr)
Fbrida. permanents; -
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_ ~'lalTG~`~ ~ ~r~rr'r~% ~'Recro Al
Sworn t~.aa anbs<r,-bea before me this -1~ day of 1~1-ar' L~. r , ~ /'-~a S/s2
A.D. l ~ }
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~ G ER K OF G I RC U t T COt~2 T
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~lC 1 G~ItTY; Ft 1 OA - -
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s ~.`J•;. EPUTY LERK i
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