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TOTIIE CLBRK OF TlIE C1ACUtT COURT, ~ 4~33~
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_S_T_L L UC 1 E CpUM'Y. FLORiDA:
~ '1'ab b mr declacation of Domieile and Cilisen~hip ie 1Ae St~te ot Fiorida tAat I am fiting tAV d~r in accordance. and tn
~oatotaaitr witA Scction 2~.1T. Flo~ida Statutes.
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I w~a ~an~nerl a ie6a! reaident o~ ~ ' ~ I
~ staal
celWed at .~,~~0 ~ • - Ho~nvee. I have ehanged my domicile to
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aad am u~d bav~ been ~ bona fide reaident oI the State ot Florida ainee ~ d~r
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19~ sad I re~{de at
Ig ~m~rl
' _ ST. lUG 1 E Co~+4cy. Florida.
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and tb~ st~temeat is to be taken a~ my declaration ot eitizen~hip, actual kgal cc~idence and daaticile in the Stato ot Flotida.
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IF iOR THE PURPOS~E Of ENROIIING Ii fOR HONESTEAQ PURPOSES~
CHILOREN IN SCHOO~~ PLEASE STATE ~LEASE CHECKS ~
THEIR NANESS
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S'f. Cl~tf~'L'O~FIA.
ROCER'OITRAS
CIERK C:RCUIT CO R
w ' irPIFIEO
~ _ -APR 18 1016 AN'18 ,
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I FURTHER CERTIFY that I wt~l register at mr Icea) addresa when the registration book~ reopcn. aad comply with aU
other tequiremenu oI a lcgal resident of this State. - ' -
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~ " I FURT 't CBRTIFY t t I haveyq
~ intention to return to my iormer domicile. ~nd I intend to remain in
I -~U~,._~ ,(~j ~.c~~.-~ $T . L U C 1 E _ County.
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~ Florida. permanenti~ .
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~ Sw~to i~d subserit~cd bc(oro pio thi~ dsy o~ ~ ' ~
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~ R~66EP1 P01 S, CLERK OF C IRCUIT COU2T
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~ ST. L UG i E COUNTY, F l.Oft 1 UA ~ '
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