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~ TO TNE CI.ERK OF THE CIRCUIT COURT. , ' . • , .4?' : ~
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ST lUC i E
~ COUNl'Y. FLORIDA: ~ ~
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T~s b my decluatioh o[ Domicite and Cittzcaship in the Siate ot ~'lorida that I am filing thls da~ id accordaaee, ~nd in
contormitr with Seetion 222.1T. Fbrida St~tules. •
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I waa iorm~r~ a ksal reaidant ot - ( s Q,DSSc=' .~~t y~ ~9i C`I ~ 4A~ . snd 1
ICty) IStae~f ;
resided at ~ C~C/~ gA~2 . Howevee. I t~av~ chan
( wd N bx1 . 8ed eny docnicik to •
~nd am snd have bcta a Doeut Cide resident ot the State oi Florida ~iACe .~f~_, day ot
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..19_t.~, aod I reside at iy9 ~/1~,,, '
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(Strwt aad omb.r! t'
a~2 fi S~ ILc,tC~~ ST, lUG 1 E Couat -
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~nd this statemcnt is to be takca a~ my detlantioa ot citizet?'ship, actuat tegal reaidence :nd domicile in tbe S4te o[ Florida.
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If fOR ?HE PURPOSE Of ENROLIlkG IF iOR NOHESTEAD PURPOSES~
CHttOREN !N SCHOOI~ PLE/1SE STATE P1.EASE GHECK: ~'--f {i
' T H E 1 R N A!1 E S t ,~,,.,__..i - Y'
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` ~ E LEO AMp RECpRGF D %
- -L t ~ ~ /LC ~6%iJ .v'~ S~. lUClf COUMTY FL A. • i
aOC~R PptT~t4g `
ry~n r' ~ ~UIT GCUR. •
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~ J~i Z8 JZ oo PM'78 ~
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I FIJRTHER CERTIFY that I w~7i register at my local address when the registration books reopen. aad comply wiih nll
other requirements ot a legat resident of Lhis Siate. ~
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I FLJ~T~IEc~ CE~tTIFY that I have no intention to teturn to my formcr domicilc. and I intcnd to remain ia ~
t b2~- S~- ~Cir ~__$T . L U C 1 E - Co~nty ;
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Florida, permanenti;. ~
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Sw•orn to end subscribrd bcforc mc this ~ day of J~
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ftOG~R P01'[R~1 CLERK__t?F C 1RCU! 7 COUf2T {
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SX.. L UG 1~ COUNTY, f lOR 1 U/~ ~ _
BY: ~ . ~ ~ ~ ~ ~ .
~PUTYZ~LCRK 4~ ' ;
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