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4302~35
TO T11F. Cl.I•:I:K OF'P! [l~: GIRCUIT GOUR9'.
$T . L UC 1 E COUN'PY. FI.ORInA: -
This is my declnrntion ot 1)omicilc and Citizenship in the Stale ot Florida thnt I am IiGng thiati dey in accordnnce, and in
~onformity with Sectiai `''•.1..`'.17. Florid~ Statutes. . C,~ y. _ _ .
.
1 was fermcrl s legal resident ot 1~~~~~~ ~ ~?nd I
ICIiYI f ate)
msided rt 1 ~ .}iowever. I have changed my domicile to
(3tmt wd Nutnber) -
and am and hnve boen a bonn tide resident of the Statc+ of Florida aince day ot
~,9~, nnd T reside at
(St NumDstl. _
~ ~~G~(~C.Q__i ST. LUG I E County. Florida.
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and this statement is lo be takon as my declaration of citi~ertship, aMual legal residence and domieile in the Ststo ot Florida.
~F F'OR TNE FU~pO~~ Of ENRO!llNG IF FOR HOMESTEA~ PURPOSES~
CHILDREN 1~ SGNOOI~ P~EASE STATE PI.EASE CHECKI ~
. THEIR AMES: / _
~ _ y . a _CURC~' ~
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!79 I ~ P~! ? : 25
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I FURTIIEIi CF.RTIFl' it~at J will rep,ic:er at my locnl address when the re~istration bo.~~s reopen. and camply with ~,Sl
~ o.h~r requiremeRts o( a lefial msident oi this State.
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I FURTI1F,:t EHTII'S' t z4~ 1 1~-r. no intrntinn to mturn to my former do~~, and I interid to rc~nsin in
~ T~.~..~UG i E .County.
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~ Florida, permanemi; .
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