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430015
TO Tilr: CI.I:RK UFTIIE CIIlCUi1 COURT,
ST. LUG I~ COUNTY. F'L(1RIDA: . f
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This is my declnrntion a( I)omicile and Ciluunship in the Stale ot }~'lorids 11~at 1 r.m tiling thi~: day in eccordancc. nnd iu
conformity with Section 2`~2.17~ Fiorida St~tutcs.
1 wss fonn~rl • a legal resident ot ~..f- Gd w~-~'- . S nnd 1
(Cilyl (St~te)
resided at L~~ C9' r a~7 , ~ B d v-'~'~ w°'` ~ . liow~ver. I hnvo changed my dur:~icile to
~Slreet Rod I~umDK1
~ r-d " _ aR or `
end am nnd ha~ c I,een a bona fide residenl ot the Stnte of Floride sinrn - Y
~ v~l ~irdr ~ ,19.~_. and I reside at ~~/a~ ~l'` n~ ~"l~ ~2~tr" _
(Slreei u~d Number)
, C C • Count . F'l~~iidr.
j~p r-~- :S~ ~-~i ! ST L UG I E y .
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nnd this slatem~nt is to be takcn ns tny declaratioi~ oi cilizcnship. actual lega! resid~nce and domi:ife in lhe State of Florida.
IF' FOR 7t~E PURP~OSE OF ENROLIING IF F'OR IIC~MESTEAD PURPOSCS~ °
CHILDREN IN SCHOOI~ PLEASE STATE QLChSE CNECK2 ~ :
THEIR NAMES2 }
~ L~e / C~ ~~ci~son ~ ~
~ f1~E0 AtvD RECOROED'-
~ cl". LUClE CCUNTY FtA.; :
~ ~5 Fj ;
~ 4300 ~
~Zg JAN 8 PM 2: 24 ;
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CL.ERK C:~~-v~T C~JRT ~
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I FUR1'ItF:Ft CETiTIF'Y ih'. t I wil! re~ister ai my local address N~hen tLe regisir:.lion books reopen. and comply wi;h ali
j oth~r rc~quiremcnts of s Ic~:.l rrsid~nt o[ this Statc. ~
~ l Fl)!2TlII~.;2 Cb:it1'IFY ih^t. 1 h:t~e no inie•nti~n to rMurn to m forme•r donV uc^ilc, and I ir.icnd tu r~main in_
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- C~+•~,rii t~~ :~n~l ~u:~~cril;~ d l~rlorc rn~r thi., ~ day of ~O ~I ~T• •~-t!G ~ G~ /~L 3
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