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'fhi~ is mv ~I~•ri:u:~ti~,n c+f 1)u~t~irilr .cn~i ('itir~•n.lii~i in thr Stat: c~f (~luri~la th:~t 1 am filinr thi, day in
:iccurclanc•~•, :inc! in 4cinic~rmity ~~~ith S~ctic~n ~~~.1?, I~luri~ia Slatul~s.
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1~vati fc~rmrrly a 1.•,~al n•si~l~~nt ot~ ----------!~1~~~- and l
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rrsi~ird at ~~/2-°5=~---~~ . llo~~~cv~r, l h:i~~c chan~;~d my domicilc to
(Slrr~t ~nd Kumtx•r) ~
and am and 1?avr b~~cn a han.i liclr resi~icnt c~f thc Statc of rlorida sinc~ day of
- - 1~_~'L anci 1 resi~l~ at ~~!2 ~ _
(Slrrct a~d Numbc~)
2~~~ , -t' ~ Cou~tty, Florida,
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and this statrmrnt is to Uc takrn as my dcclaration of~ ritizcnship, actual kgal residcncc and domicilc in the Statc
of l~loricla.
(Inseri herr any p.tUn.•nt facls, such as x:wle of prnprrt~• ar hu.iurss, or relinqui~ehment o( employment at furmer ~
domicile, rtmocal uf tamily to nc~v Jurnicilr. pu~~hasc ot home. rIC_)
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fllE~ ~(HO RECORDE~ ~
ST. I,UCIE CQi1NT1 F~A. ~
ROCEA PpiTRAS
CLERK CtRCtilt COUAT
RECORp yERIF1E0_~_
Auc 9 314 PH '72
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1 rURTHI:It CERTII~Y th~t 1~e•ill m~ister at m~• loral addmss when the registration books reopen, and
comply with all othcr requircmcnts ol a Ic~~~l rrsidrnt of this Statc. i
I rURTH1:R CI:RTIFI' tl~at-1 ha~•c no intcntion to rcturn to my former domicilc, and 1 intrnd to rcmain in
~ ~ -iu-<-e. , ~ , County,
f=lorisla, prrmanrntly: - (c~~r~
STEPHANZE GZA ER
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~ ````~~~`~GU~T i~~,' (AdJress) ~
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S~~+~ i 4~icfor. mc thi, day of -
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(Tu br r~~culcJ ~n du~~h.:~lr ~nJ ~~it; in.~l f~L•J ~~ilh l'Ir~A ('itr~ul ('outl, ~nd Juphrala ~~•ul~ 7a* Asw•sW~r)
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