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. '~h b aqr deelwatioa ot Daaieib ~nd t:ithea~hip W tbs St~te ot Florida that I un Glin= thb dyr ta ~oooe~danee. sad iA
eMfo~an~? ~vkM Soetioa 222.1T. I~'brfda Statdt~et.
1~ras t~~ a ktal ~ o~ Q , and I
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~ided at ! / iY _ A!/~' i - Howaver. I ha~e cbaa~ed a~r domie~c ta
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ud am ud haw beea ~ bona Gde s+eaideat o[!!~e Stats oI Fbcida stoos day ot
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.T ~,r~ /'f.; h L L~ ST. lUG ! E Cow,cy~ fl~ia,,
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~ ~sd tl+~s statemeat b to be talcep ~ my dectaratiou of dtizeaship. ~etwl kg~l r~sideaco and domie~e tu tho State ot Fbcida.
. IF POR THE PURPOSE Of ENRO~IIHG . IP iOR HOMESTEIlD PURPOSES~
CHII.OREN IN SCHOO~~ PLEASE STATE PCEIISE CHECK: ~
THEiR NAMES. ~
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I FUR7'~IEIt CERTIFY that I wal register at my loca! addnss ~nc~a thc rcgistration books reopca. and comply ~rith all
otbtr reqniremeats ot a kgal resident et this State.
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I F[IRTHE~ CERTIF'Y t6at I l~ave ea inteation to return to my tormer domiu'te. and I intcnd LO MiAiIA in
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n F•7--~~•• LC , ~ ST . L u c ~ E , County.
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~ Swan to nd subser~ed bcforo mo thia dar o[
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A.D.19 ~ 6- S~l A1 qS
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~ ~tOGER PO NTRAS. CLERK OF C IRCUI T COU2T - ~
~ ST. LUG i E COUNTY, f LOR 1 UA • - : .
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~ EpUTY ~CRK _r Ok .
E ' : BOOK ~+v / PACE
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