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[?~~~b~r~t~oa~ ~f C~Qn~6ci~e ~r~~ ~
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TO TH~ CI.l~:RK OF THl: CIRCUIT COURT.
S7. Ll1G I E COUhTY. FLORIUA:
This is my decla~ation of nomicilv and Citizenship in the State of Floridu that I am filing this day in accordance, and in
contormity w~ith Scction 222.17. Florida Statutes.
I was tarm~rt • a lcgal resident ot J 0~'L F/Z-y~ ~Q end I
. Q ICity). IState)
resided at Q l L L
O IV , However. I have changed n~y domicile to
(Street and NumDerl
u?d am snd have bsen a 6ona tide resident o[ the State o! Florida aince / a~~ day o[
~/B ? .19..~_, and I reside at 7`f q ~ S+ ~B/~ ~O $.T
(Street u?d NumAer)
P~/~T ,S%
, L uC ~ c ST. LUG 1 E Gc?unty. Florida.
.
~c~t,~
and this statement is to be taken as my dcclaration o! citizenship, actusl Iegal residence and domicile in the State of Floridn.
I F FOR THE PURPOSE OF ENROIL ING I F fOR F(OMESTEAO PURPOSES~-
CHiL~REN IN SCHOOL~ PIEASE STATE PLEASE CHECKS ~
THE 1 R NAHES: ~
~
.
I FURTIiER CERTIF~' that ? will rc~gister at my lxal addrrss when the registration books reo~?en. and comply wilh all
other reyuiremrnts of a legal resident oi this State.
I F~l2i IiE~ RTIF~' thst I hAVe no intcntion to return lo my former domiciie, and I intend to remain i~
~ ~-~~--e , $T j L U C 1 E _ County.
• (CitYi _
Florida, permanemi; .
~~COUNly ~
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d'J' ~'.!yP I.v4~•' t`~ -
(~~,~F.°.: wEw+ ~ o (tQamc)
, ~OUN~' `
~ 4~ ~~:~C t E _
(Addres,)
Sworn lo nnd sub~critu~d b,•;,~rc me t~iti da~ of ~'-~1' ~-3 ~SZ ~
n.n. i~. ~I ~S
+ ^ f LEO AMO RECOAOEC ,
S~.IUCIE COUMTY Fl~
Ro~,~R r~~~ ~_T?A.S,._CLF_i2K_ G~ C t RCU I T COU? T nocEa PoiT*R~s .
- r!c^r i.~~CiV~f L~Up'
ST. Ll1C ( E CQUNTY, Fl O;'t 1 UA '
~ Ma~ 2 az ~N'1R :
-~a~-~~:, E;~ K 401921
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