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Declaration of Domicile and Citizenship
~3'7'704
TO THE CLERK OF THE CIRCUIT OOURT.
ST. LUG I E ~pUNTy. Ft,pRIDA: . .
This is np deelaration of Domidls and Gtitiseaslup in the State ot F7orida that I am Slin~ this dq in aooordanos. aud in
coniormity ..ich sscct«, r12.17, Fforia. sawte.. ,
I was former a kgal resident of -l~~ „~/U ~1 1~~~0 and I
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reaided =t '7n LGYF S T ~ 1"~ ~ sT, However. I bave cbartged m~ domic7e to
l8trwt a~ Nas~r)
and am and have been a bona fide reaident ot tbe S4te ot F7orida sinoe ~Q~l~ dq ot
T~tI . .19~~ aad I r~side ai ~l/~?_~~E~l/ >'f~ 7~ `5~?- .
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~iF ~tZ~°-~ ~ ST. Ll1G 1 E Count~. F7o~ida.
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and this statemeat is to be takea as m~ declaration oi eitirenship. aetual kgat residenoe and domic~e in t6e 3tate of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES~
CNI~DREN IN SCHOO~~ PLEASE STATE PLEASE CHECK: ~
THEIR NAMESS
~~~aPRA ~ ~i1i?~S/AM
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'79 I:'-~ 19 P~i t? : 36
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; I F'URTHEA CERTIFY that I an71 ngister ai my local address ~vhen tLe ngistration books reopen. and eomply with all
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other requirements of a kgal resident of thia State.
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! I F[JRTHER CERTII~'Y that I have eo inteation to return to m former damicile, and I intend to nmain in
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. . County.
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~ Florida. permanentl; .
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w 3w?orn to and aubsen'bed befon me this _LL- day oi ~ ~
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; /~"1 A 2 L A.D.19_ . :
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~ ROGER P01 TRAS, CLERK OF C IRGUI T COI~tT ;
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~ ST. LUG i E COUNTY, FLOR 1 DA ~ ~ . - • ~ ' ' ~
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~ BY. u . - ~ ; ~ F ~
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EPUTY LERK
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~ Ar>(l Form ?S 22
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