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Dectarat~ion of Domicile and Gitizenshi i'
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448'744 ~ ,
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TO THE CLERK OF THE CIRCUIT COURT. ~ ;
ST. Ll1G 1 E CpUNTy. FI.pRIDA: ~ i
This is m~ declaration of Domic~e and G~t~rxaship in the State oi F7orida that I am filing this da~ in accordance. and in
conformit~ wilh Scction 222.1T. Fiorids Statutes. '
I was formerlv a legal resident of ~ I~L S~Gl r` a~ , f~i.tl~ls yl ~ nN~~ and I
. r ICit~) (Statt)
resided at v ~l ~ I~ However. I have ehanged m~ doinic~7e to
(Street aod Number) •
and am snd have been a bona fide resident of tl~e State oi Florida since da~ ot
, mTy .19.~_. and I reside at o~~~o ~ J•~. CQ1^~'1 Q 1 d/l/
(3treet .nd Numb~
S~~ Lke.« , sT. LUG I E Count~. ~ria.,
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and this statement is to be taken ~s my declaration of citizenship. actual 1ega1 residence and domicile in t6e State oi Florida.
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IF FOR THE PURPOSE OF ENROILING If FOR HONESTEAD PURPOSES~ ~
CNIIDREN IN SCHOOL~ Pl.EASE STATE PI,EASE CHE_CKt ~
THEIR NAMES:
~'.c /~,r ~`fn~~/. /II a r ~ n q - .
i c 1t 4 e ~ W, I ~i w vm I~o e~ r~' h~,? ~
>3I~ J~~ ; 21 P~~ 1= 03 ~
ba l t~- L.~ rYl o e h r~ ~ N~
. }Atu At~eO f¢ O ~
STMt~ PGd7~ ~
- Q~lrt t~ C
PEf J~f".0 VER~Fi~
; 448'744
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~ I FURTHER CERTIFY that 1 wi71 regi.ster at my local address when the registntion books reopen, and comply witb aU ~
~ other requirements at s kgal resident of this St.~te. ~
~ I FURTHER CERTIF'Y that I have no intrntion to return Lo my former domic~e. and I intend to remain in ~
E T. U C i E ~~~ty,
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F
~ Florida. pertaanenti~ :
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~ Sworn to and subsrn'bed before me this da~ oi / a/' Z~T ~6i C/' C, 3
° A.D.19_ . ,
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~ ROGER POI TRAS. CLERK OF C IRCUI T GOl~2T .
ST. L.UG 1 E GOUNIY, f tOR t DA
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EPUTY IERK ~ 311 26~
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