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DeGlaration of Domicile and Citizenship
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TOTHE Cl.BR1COF?N~ C1RCUlT00UAT.
ST. LUC 1 E ap~Y. ~,p~~;
11l. r a~ aKLr.tbn ot noavie~M ,wa atb~ is tb. 8~.~. or Fto~w. tM.c t.m miu~ tha a.,~? ia .~ooora..o.. .ea i~
eo~tonait,~ witA ~etba ~8t.i7. F1o~idR Staf~f~s. .
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aad tlis s~ateaoeat is to b~ talo~n a~ m~ deeLratioa ot ~a~ip, aetnat ie~a~ ns~idenee asd domkik b~ tAe 8tate oI ~7o~ida.
If i0R THE ~URPOSE Oi ENROL~iNG IF i0R HOMESTE/10 PURPOSES
CHILDREN fN SCHOO~~ PLEASE STATE ~LEASE CMECKS
TNEIR NAMESt -
- fItEC ~fL'3RDE0
- ST.IUCif ~OUtITY FIA.
RaC£.~i ~~IiRAS
Clf R?c ~i:: ;~IT COURT
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I P'tJRTHER CERTII~'Y that I ~n71 regist~er at mr loca] adde+ess w1Kn tbe re~stataa books i~eopea. aad ooeapi~ with aU
other requie~emeab ot a kgal resideat ot thi~ State.
I P'tJATAER CEItTIFY ti~st I have no intentioa to e+etura to m~? fonaer domka'k. and I ii?tend to remsin ia
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QOG~ER'-~ TRAS, CLERK OF C IRCUI T COl~2T ' -
, ST. LUG I E COUNTY, FLOR t 0A '
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uTY LERK -
~ ~ BOOK 245 PA~E ~8?~
AfiO PonnTi 77~
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