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Declaratian of Domicile and Citizens p
546191
TO THE CLERK OF THE CIRCUIT OOUIiT. .
ST. LUC 1 E _ OOUNTY, FLORIDA:
- This is m7 declaration of Domidle and Citizenship in the State of Fbrida that I am Sling this dq in acooedanos. and in
eoatormk~ with Section 222.17. Florida Statutes.
I was to~ a legal resident of ~
S / _ ~ ~ L - ~i~ ~l~ sad I
resided at / e •¢a?D 1~~4.? /,~~.4 ~ dil/C~ - Hcwever.I have ehaoged ~ domicils to
(t)t~wt sad Nu~~L~d
and am and have been s bona 5de resident ei the State a[F7orida since ~ ~ ~ al
_ jY-OVF~f6~'~ -19~ and I reside at ~ d~ EN7ct~ O o.d
(8errt aA N~,ia~r)
~D,e ~T ~ ue _ ST . LUG 1 E Coant~. F7otida.
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and thin statement b to be taken se ~ declaration et citizenship. a+du:l legd :esideace and domicile is the Stall of Ir'loeida.
" IF FOR THE PURPOSE OF ENROLLING i~ FOR HOMESTEAD PURPOSES, ,
CHILDREN iN SCHOOL, PLEASE STATE PLEASE CHECK:
THEiR NAMESS
fILEO AND F'-~:"'CFD
A:
546191
~i I FIJRTIiER (~Et17,F'Y that I wID rege~der at mT total address when the rege:teation boob reopen. and aomplT with all
` other iegairements of a legal resident of this State. -
I FURT~R CERTIFY that I have no intention to return to former domieDe. and I intend to remain in
u ) E C~ntJ.
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Florida. permanents; • '
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_ fi' d•.~~. NN`
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Swera to and sobseribsd betere ms this ~ dsJ d
ROt~ER P017RA5,~, CLER Of C RCS UI T_COt82T
ST. LUG { E COUNTY, f t t UA
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- - 9Y: -
EPUTY LERK
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