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Declaration of Domicile and C~tizenshi
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50'7623
TO TAE CLERK OF THE CIRCUIT COURT.
ST . LUG 1 E COUNTY. FLORIDA:
This is mp declaration of Domia'le and Citizenship in the State of Fbrida that I am 5tiag this dad is aooordaace. and is
ooniormitT with Section 222.17. Florida Statutes. 1 l
I was formetts a legal resident of ~ `1~'m~-' O J ~ l~ _ S~-t-- and I
1(~t7? I8tate!
resided at -However. I have changed m~ domicile to _
IStrMt ~sd Noobw? +
sad am and have been a bona tide resident of the State opt Fbrida since _T,
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~ ~ Q ~7 d
19. - and I reside at 'tea S .S • CJ , (.~.5 ~ ? C~~; ~
(StrMt~sdNae?ber?
Pa r~ S~. L.u.c_~ ~ _ ST. LUG I E CouatT.>~7orida.
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sad this statemenr is to bs fates a. mT deeLration of eitisenahip. actual legal :eaidence and domicile in the State aE F9arida.
" IF FOR THE PURPOSE Oi ENROLLING IF FOR NOMESTEAD PURPOSES,
CHILDREN iN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMES:
~~7, ~-art C~ _l _r~ ~ ~ ~`Y\;,Y, ~ ~yL
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- 50'7623
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L I F[JR'I~ER C=~'Y that I w~ register at mT loin address when the registration books reopen. sad comply with aU
other r+eyaireaseata at a legal :+e:ide~ aI this State.
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f. I T'URTAER CERTff9C that I have no inteatioa to return to my former dome. and I intend to remain in
_ _ -Coast
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~ Florida. permaneau; . •
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- Swam ~oa0sdsabaQibed betas me this ~ daT al ~tpx~ r`.~~~J
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ROGER POITRAS. CLERK OF G1RGU1 T COt~FtT
~ ST. LUG t E COUNTY, LaR 1 OA
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EPUTY LERK
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