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Declaration of Domicil~ and Citizenship
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TO TEi~ CI.ERK OF THE CIRCUIT DOUAT. ~ _
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ST. LUG 1 E aptJrrrY. Ft,otunA:
1Li. b a~r d~claratioo ot Domkils aud C~itis~a~hip fa ths 8tate ot ~'todds tbat I am tilins this da,~? is ~ceoe~d~na. aad 1n
coobcmity Mritb Saetion 282.17. Ftorida 8tatu •
I~ra~ to~ a{egsl raideAt ot ~ I
~ tseahi
,+e~ided at /'~-tQ . - Hawwr. I 1,av el~aa,~d aq~? domiei3e to
1~++~t ni N~rbKl '
tad am ae~d bave been a ba~a fid~ r~ot ~ tbe State a[ Fb~id~ dnce ` /
- 1~.~.... and I resid~ at `
(8tiwt ~d Ii~~tl
~ ST. LUG i E ~y,
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aad t6is ststemeot b to 6s takea u my deelaration ot dt~enship. utual le~al resideace a~d domidle In the 8tate ot Flo~ids.
IF fOR THE PURPOSE Oi ENROLLiNG Ii fOR HOMESTEAC PURPOSESi
CHILOREN IN SCHOO~i PLEASE STATE P~EASE CHECK: ~
THEIR NAMES2 -
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- ' FItEO eH: Nfti0RDE0
, / ST. IUCi~ ~i;UMTY FIA.
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ClE,.K C~~C!!:' COURT
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. Nor 10 f z9 PM'1~
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f I FURTHER CERTIFY thst I w~71 register at my loeal sddress.wl~ea the registntioa books rsopen. snd oomply wit6•all
R other cequirements ot a kgal resident of t6is State. ~
F I FURTHE~ CERTIF`Y that I have ao intention to nturn to m former domieik. aad I iatend to remain in
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~ ~-~,a~'bicribed before me this day ot -
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_ ~D{~@ A.D.19 ~
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ROGER P01 TRAS~ CLERK OF C IRCU T COI~tT
ST. LUG 1 E COUNTY, f LOR 1 UA
~ BY: ~ '
EP LERK ~.R ~~5 PACE~V~O
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