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Declaration of Domicile and Citizenshi
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496855
TO TH$ CLERK OF THE CIRCUIT COURT.
ST . UG I E CoUN'!'Y. FLORIDw:
This is my declaration of Domicile and Citizenship is the State of Florida that I am SIiaK this dq? is accordance. and in
conformity witb Section 222.17. Florida Statutes. -
I ass formerl a kgal resident o[ ~ 4 ~/S ~/i~LG ~ C~ ~ I
_ lCS<y) 18tw)
resided at ~ ~i9a7 ~ T - Aowever. I have changed my domiei7e to
18trMt sad Numb~t) ~Y '
and am and have been a bona fide resident of the State of Fbrida since ~ ~ day of
__191Z..analresideat °3y9 ~A'~~GIJT
18wa sad NambK)
Y S % G ~ ~ ~ ST . L UG I E ~ Couah. Fkrida.
ICit7)
and this statement is to be taken as my declaration d citizenship. actual legal rasidene~ and domiale in the State o[ Florida.
IF fOR THE PURPOSE OF ENROLLING It' i0R HOMESTEAD PURPOSES, ~
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES: ~
i~~ i L y.y~ ~c2~L
Aso aUC 20 ~ it a 8 _
- FIlEO t~ E~ COrD[D I
S1. LUCIE CCUN I Y. FL A_
ROGER POITRAS
CLERK CIRCUIT COURjO
RECf1Ri1 ~E&IFIEO__..._~ _
•496855
j I FURTHER CERTIFY that I w~71 register at my local address when the registration books reopen, sad comply with all
other regairements of a legal resident. of this State. •
I FURTHER CERTIFY that I have ao inteatioa to return to my former domicile. sad I intend to remain in
_ 5T uc.~_ .County.
j - ICSty) _
Florida. permanenci;.
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S.vorn to and snbsrn'bed before me this a 0 day of
• EMNA l i eRC~
- A.D.1 ~ ,
ROGER P01 TRAS: CLERK OF CIRCUIT COt~2T
ST . L UG I E COUNTY, f LOR 1 OA - .
EPUTY LERK `
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. ~ g~~~37 P~ 155
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Arn Fo-m 71 22