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` Declaratio~~of Domicii~ and C~~iz~nship ~ ~ '
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~ 39~8296
TO TliE CLERK OF THE CIRCUIT COURT. ~
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STt LUC ~ E COUNTY, FLORIDA:
• Tht~ b my deelaration o[ Domicile ~nd Citiseo~hip In tl~s State oi Flocida that i un GIFng tAta dar tu atoorda~ce. and in
aontocmit~r with Section 2?'1.17, Florida Statutea. _ '
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I~?as tacmeri a legal te~ident ot 1~1 ' . ~ . 1 y~) and I
raided at /~n ~M~.~~'~/` p - However. I Dave clunged mr domicile to
lSter.t u~d Nump.r? - .
a ad ata and haw been a botu Gde reaident ot the Staie ot Florida aiace - dar ot
,
~ • • c~ • ~ ~ ~ 19~~. and I reaide at ~~1~w L . - . -
(SerNt asd Numbarl
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~ ~ ,~,~'7,~~- - -~'~r ~ - _ ST. Ll1G i E Cou~cy; Flurida.
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and thi~ statemeat is t~o be takea as my da4rstioa o[ eitiun~bip, aetua! kgal residence and dotnicile in the Stato at Fbrida. -
Ii i'OP. 7:iE PURPOSE.Of ENROLLING Ii fOR NOMES''EAO PURPOSES~
GNIIOREN IN SCHOOI~ PLEASE :.T!TE P6EI15E CH£CK2 ~
THEIR NAMES: `
.:r.~.:bP~-~-~- (.~E'.u.-„~_ -
frtEO AND RECOROf U
C~L t1: ~1 /L- , ST• RO~ERCOUMtY FZA.
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/ ' C~ r••x CUtT ~AS
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~laR 19 4 n6 PH'ZR
. ~ 398296 ~
I FURTHER CERTIFY that : will register at mr loczl addres~ ~?hea the regi~tratioa books reopea. and comgly ~rith all
other tequire~ne~t~ of a legal resident oi this Stste. -
I FURTNE CERTIFY tt~ai I llave no, intxntion to nturn to my focmer domicil~. and I intend to remain in
L~ .~oJ~' • e $ T. U C 1 E _ Co~nty.
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lpt~) . .
Florida. permanenci~. _
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Swora to and subscribed befure mo tl?is __~z~
:L__ dav ot -
• //LG~~ ~ A.D.19!{~
ROGER P01 ~RAS, CLERK 0~' C IRCUI T COIxtT
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ST. LUG i E CnUNTY, FLOFt 1 UA •
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. E P U t Y l E R K dO~( 2,8~ OACE ~ t7~
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