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L~~cl~rat~on c~f D~m~c~le anc~ C~t~~~nsh~p _
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TO THE CLE;AK OF THE CIBCUIT COUItT. ~2g~ 38 '
____ST. LUC i E covNrr. ~.otune: . ~ ~
Thb is mr declRratioa oi Domlcile aed CltisQnship in ths State o[ i~lorida tAat I w t~ tAis dy? iA ~eeordaace, and in .
~oatornp;ty witb Sectioa 222.17. Flo~ida Slatutes. ' ~
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I wa~ i rmc~l a kg~1 sesid~at o! SIIt13~S~ ~
r/C!/T and I
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~ e~aided at ~.S/~N~ 1 ~ L R Q/~' - However. I havo ehae~ed my domieik to
1 Md Nu~el .
~nd am ~nd havo beoa a boaa fidc resideat ot tbe State ot Florida slaee s ~r d
~,~~1 ~ _ -19~ anJ I nside at Z00 ~ Q~/~ p.s ~d/~'~
- (&nN wd Nnmbr)
- rp~ jD/~ ~~N~ ST. LUG 1 E - cotinty.~o,~a., F
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aad this statement is to be takeA ~s mr dec4ntion oi citiunship, actual kgal resideneo and domieile in tho State ot Fbrlda.
Ii POR THE PURPOSE OF ENROlliN6 IP FOR HONESTEAD.PURPOSES~
, ~HILDREN IN SCHOOL~ PLEASE S?ATE P1.EASE.CHECK2 ~
THEIR NAMES: -
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R~bu~r ~ ~ l~vn~,~ ~ -
st
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c ~ ouKiY Fi,~i. ~t
ROC~n r"vIT4~5 ~ ~
- CL=RK v;Z"vii1:' COllRT -
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I F1JBT~IER CFRTIFY tha~ I~vill reg~~ter at my local address when the registr~tion books reopen. and comply with all ~
other requirements ot a legal resident oi this State.
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f ~ I FURTHEZ CERTIFY,~tfiat I have no intention , to teturn to my tormer domicile, and I inLcnd to remain in i
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~ I~ brida. permanc~ti; . - ~ ~
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F Sworn ta and subseriLed laetoro mo this y of ~ ~
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~ ROGFR P01 TRAS~CL~RK OF C IRCUI T COU2T ~
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~ ST. LIJG i E COUNTY, F LOR i UA ~
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PUTY LEItK
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