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TO THE CLERK OF THE CIRCUIT COVRT. . }
ST. LUG i E , ~p~. ~,,p~~:
Tbb b,»y declaratbn ot Dankile sad Citi:easbip ta tbs Sace oi Fbrida cba~ i sm tiua~ chis d,a? in aooordance. and ta
eoafonnit~? ~rlth Seet~oa 7?2.17~ Flodd~ Statuta.
~A .
1 ~?as t rmerl a kgal resident oi f
EIPA/ D/~.~C E ~ !~/y and I
. ICity) ISIat~1
resldad at =1~ 3 s EA RL R L v fl Horrover. I bave cbsnged nyr doraicile to
lBtrNt aad No~rl .
aud am and have been s boaa t'ide resideat oi tbe state ot Floridi since G- 9 dpr ot
3 ~i-oo,~ !2! C ~
19 and I ceside at
~8srres ~ t~s~
~o R?' ~1 c i _ ST. LUG ! E Counc~. Fbred~.
and this statement b to bs taken a~ ~r deelantion ot ejti:enship. aetnal kgal rasidenee and domicDe iu tbe 3tate ot F'torida.
If fOR TNE PURPOSE Of ENROLLING Ii FOR ~IOMESTEAD PURPOSES~
CNILDREN IN SCHOOL~ PIEASE STATE PLEASE CH~CK:
THEIR NAMES2 ~ ~
ST~UC f COUMTY FIA. ~
. ROGE ~ ?~!=RAS '
CLEAK :;nC~~ COURT ~
°F~E'RL• !+ERr~lEO
31s~ s~ a io 4~ ~~75
l FURTHER CERTIF'Y thst I w~11 register at my local address when the regisintioa booka raopen, and comply w~th aU
other requirements ot a legal reside~t ot this State. ~
I R7'~iE~ CERTIFY that I have ao intention to re~urn to my [orneer domicile. aad I intend to rrmaia in ~
o~r* T S T ~ w~[ C _ S 7. L u c ~ E . County. ~
(GTiy) . ~
Florida, permaaenii; . ~ a
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"~y. f,,ti.. _
. , IN~mel
(Addrew)
Sworn to and subseribed before r~ this day ot •
A.D.19 7S
ROGER P01 TRAS~ C~ERK Of C IRCUI T GOURT ~
ST. LUG 1 E COUNTY, f ~OR 1 UA -
BY: t,~
PUtY LERK
~ Bo~x243 ~~104
- ACO Form 71-22 '
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