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~CC~ara~ion ofi Damicil~ and Cifiz~nship
' 5129~3
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TO THE CLERK OF TNE CIRCUIT COURT.
ST. LUG I E CoUt~t1'Y. FI.ORIDA: ~
This is m~ decleration oi Domic~e aad G~tiuaship in the State oi Florida that I am fling this da~ in a«ordanoe. and in
conformit~ a~th Section 222.17. Florida Statutes.
I w•as formerl~ a legal residcnt oi ~~~ ~~d , ` ~`^'^ and I
1~~1 IStatel
msided at ~sc ~ A~ e 2oc~ d . However. I bave cbanged my domid7e to
(Ssrcet and Namber) ~
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and am and ha~ e bcea a bona fde resideat of the State oi Florida since ~- 1~ d4 ~
xC~, uc.~ ~~ ,19~~ and I reside at 16 Y L ~• C ~i v~,~te~G~.. ~~t
iStreet aad Numbet)
~7-~ . 1}, (,~,~ c~,r . , ST . L UG 1 E Count~. Florida,
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and this stntement is to be takea as my detlaratioa of citizenship. actusllegal residence and domicile in tbe Stat~e of Florida.
" If iOR THE PURPOSE OF ENROLLIN6
CHIIOREN IN_SCHOOL~ PLEASE STATE
THEIR NAMES:
r
IF fOR HOHESTEAD PURPOSESi
PIEASE CHECK: Y ~
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S12943
I FURTHER CEftTIFY that 1 w*~11 register st my loca) addres~ vchen the registration books reopen, and oompl~ w ith aD
other requircments of a legal resident oi this S4te.
I FURTHEB CE~tT'II~'Y that I have no intentioa to r+eturn to m+~ lormer domie~e. and I intend to remain in ,
_._~ ,-_ yT , L U C 1 E _ Count~.
1(~c~l .
F'lorida. permaneati~.
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SR orn to and subsm'bed before me this ~ da~ of 1~
- ~D.. / 98/
RO R POI TRAS, CLERK OF C IRCUI T COCdRT
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ST. Ll1G i E GOUNTY, f LOR i DA •
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BY: ~ ~--y~ • .
EPUTY LERK
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