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Declaraiian of Domicil~ and Ci~iz~nsf~ip ~
~
~ ~ 51~.323
TO THE CLERK OF THE CIRCUI'T COURT.
ST. LIJG I E ~pUNTy. Ft,pRIDA; '
Tbis is my declaration oi Domic~e and G~tizenship in the Stxta oi Florids that I am filing thL~ da~ in accordance. nnd iio
contorinit~ ~ith Section 222.17. F'lorida Stat . ~
I was formerl~ a legal resideat oi ~~~~~~~~ ,~-p /`'~ ~~" and I
~ ~ `,1 V ~ ~ ~ U ICa~) ISt+s~.1
resided at ~/~ However. I bave ebanged my domic~7e to
(Stteet aad N~De~
and am and have been a bona Sde resident of the State oi Florids since ~ dsy of
e~ ~~ _ 19 ~/ / , and I reside at ~~ Y T ~~ ~" ~ Gt/Gi.~ ~~ ~%~-~/ ~~
~ ~f ~ (Street aad Numbe~)
P~ T. ~(,Gl L.C~ ~ ST. LUG 1 E Count~, FJo~ida.
l(~7) -
and this statemeat is to be taken as my declaratioa of citizenship. actual legal resideace and domiu7e in tbe State oi Florida,
" IF iOR THE PURPOSE OP ENROLLING
CHILDREN IN SCHOOI~ PIEASE STATE
THEIR NANES: ,
1~~mct.s -~7~'i~o-l~S ~~,~
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.~
IF FOR HONESTEAD~PURPOSESr ~
PLEASE CHECK: ~
1981 J~l~ 13 A,'~ I I~ I 4
ft:~c ~r,r x~ CUi+GEQ
5?.LUCIf CGUNSY.itM.
RCGER POITRAS
CLERK CJR.I;IT COU~Qj~
. ~i.~r ; ,•.s:~ ~ . r1/,4_~_ -
~ ~~
513323
I FiJRTHEA CERTII~'Y that I w~71 register at my locaT addresa when the registration boolc~ reopen. and eomply ~rith aD
other requirements of a legal resident of this State.
I FUBT'F~R CERTffY that I have no intention to return to my former domic~e. and I intend to remain in
,_ 5 T* L U C 1 E County.
((~t~) .
Fiorida. permanenci;.
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Saorn Lo and subxn'bed betore me this ~~ da~ of ~
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9
R ER PO I 1RAS* CLERK OF' C I RGUI T~OC~2T ~ ~~ 7~-9
ST. LUG 1 E COUNTY, f LOR t DA - •
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