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TOTI[l~: CL~R:C 01~'TJIE CIRCUIT COURT. 3Qs~z~
ST. LUG t E COUNTY. FLORIDA;
This Is my decinration of Domicile ~nd Citizenahip in the StAte ot Florida thet I am Ciling this day in accords~ce. and in
eontormity with Scction 2:1.17. Florids Slatules. ~ ' ~
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I was [ormcrl~• a icgal resi t of /?~-~r--~C~ , ~ • and I
. ~ ~ 1Citr! ISt
resided at ~ ~ < <~-< < ~ ~ ~ ~ L ~ . ~~owevcr. I havic ehanged my domicite to
(Street and Numbe~) •
a~d am ~nd have bccn a bona fidc residcnt o! ihe State ot I~ lorida since ~ day ot .
19~~. ~nd 1 reside at ~ 4 -S~T='~ - /t`y~ x S'~'~
~ (Street and NumEer)
~ ~~_~,~,,c~, ~ ST . L UG I E Cou~ty, Florida,
cc~t,y
nnd this statrment is to be taken as my declaration oi citizenship, ncluat.legal residenee and domicile in the Sta?ie of Flo~ida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOHES7EAU PURPOSES~
CFi I IDREN 1 td SCNOOL~ PLEASE STATE P~EASE CHECK: ~
7HEIR NAMES:
~l~ (L - ~ ~
fIlEO '~~~y~g~
- ST. IU~C+f G31lNTl' fl~.
ROG :F i OFt1tA'S
CIFR~. .:~Ulf'~ONRt ~j
R~COf,t' ~•c: `~.r.,...~~1++ q
. MR I8 IQ. 38 AN ~t5 ~
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1 Ftl!{TIIF.R CF:it1'Ik')' th: L I~:•ill reFi~tc~r al my 1~.;.al adrlresl ~•hen tl:r rrf:ist_rtion bo:~}:s reo~~n. and cun:ply u•ith a!I ~
o! }~cr ra guirc~nsrnts of n 1~•};.~I rc~idc•nt of this St.:tc.
l FUIt7'Ili::t Cl~fi'1'il')' ~ra~±~ Fa~•~~,uo intcr~tiou lo return to m~• t~~-mcr d~~n?icil~•. ancl 1 intcnd to n•~na.in iu ~
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