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Q~claratior~ ~f L~amicile and Ci~ixensh~p
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TO TH~ CL~ItK OF THE CIRCUIT OOU1tT. 3~~"~~~
ST. l.uC 1 E ,COVrrr~r. Fr.oRwA: . .
Tfifs b uny decluatia~ ot Dowkile aed Cilimaship ia tbe State of Fbrida t?~at I~m Gliaa thjs da,~? in aeeordan~e. ud ip ,
taafocmit~r wtth Sectioo .17. F{otjda Statutes. ~
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l was tormcr k~l sesideat of _ aad I
, lClyl t8taee)
restded at However. I bave cl~aaged nqr domicilo to
t~ aaa t~b~d . .
aad un ~ad have bceo a bona lidc r~aideat ot ihe St~te ot Flo~da stnce day ot .
19~~.. ~nd I raide at
.
~ • ST. lUG 1 E~ , Couaer. Florid.,
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and tbis sLatement is to be laken u oyr decluatioa oi eitizensbip. actual kgal resideaeo uid do~nieile ia the Statte ot Fbcida.
If fOR THE PURPOSE OP ENROLLING . IP fOR HONES7EA0 PURPOSES~
CHILDREN IN SCHOOL~ PLEASE STAYE PLEASE CHECK2
TNElR NAMtES: -
FiLEO ANb RECORpfp
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~tOCER P(~~TRAS ~ ~i'
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I FiJRT}iER CERTJFY that I wiq regi.cter at my Iocal address when the rcgistration books reopen, and eompl~ with all
other requirements ot a Icgat residenl of this Slale.
; I FURTNE;t C ftTIF~' tha havF no intrntion to rcturn to my lormcr domicilc. and 1 intcnd to remain io
f C- ~ , S7 . L U C 1 E ~ . Cuunty.
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Florida. pcrmancn~i; .
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y ~~Q,, ~/1ddrn
Sw6~~~?it~iuriLcd hefuro me thi~ _ day of ~
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~ F20GfR P_~'RAS~ CLE:RK OF C I RCU I T COU7T
~ ST. L~K I C f OUNTY, F ~OR 1 UA
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- .NUTY LEItK
~ ' ~ R 242 ~2656
600K
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