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Declaration o~f Domicile and ~itizenship ? ~
~ 4~L~938 ~
'TO THE CLERK OF THE CIRCL'IT COURT. ~
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__ST. Ll1G I E CoUNrY~ FLORIDA: f
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This is m~ declaration of Domic~e and Citiseaship in the StaLe of Florida that I am filing this da~ in accordaoce, and in ~
conformit~ with Section 222.17. Florida Statutes. ' ~
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I w•as formerlt a legal resident oi ~~k~ TR/V , LS~ ~d J `
. ~~t,~ 36 8ra~'~3 t f
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resided at _~a. G'~//U However. I have changed m~ dotnic7e to ~
- . tStiset aod Number) ~
and am and have beea a boaa Cde resident of the State of Florida since ~ day oi
Ci ,19~,~ and 1 reside at ~,~;~(~`,~flJf~~l_Cr `j~[~ ~
~ C,/' ~ I seteet and Numbvl
~ C U~'~ C' , ST . L UG 1 E Count~. F7orida,
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and this statement is to be taken as my dedaration of citizenship. actual legal residence and domic7e in the State of Florida.
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Ii' iOR THE PURPOSE OF ENROLLING IF ~OR HONESTEA~ PURPOSES~
CHILOREN IN SCHOOL~ P~EASE STATE PLEASE CHECK: ~
THEIR NAMES:
--~f~/il ~~s I ~~v l' l(.~'~~ C ~ ~
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~?19 J~~ii 22 '2~ ~
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fILtO ~?M~ rtCUnG~u
sT ~U~ COEaiTY.FLA. ~
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I FURTHER CERTff'Y that I w~71 register at my local address when the registration books reopen, and compl~ with ill =
F other requirements of a legal resident of this State.
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€ I FURTHER CERTIF'Y that I hsve ao intention to return to mv former domic~e, snd I intend to remain in ;
T . U C ( E . ~~t~. '
~ (Cit~) _ ;
Florida. permanenti~.
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~ Sovorn to and subsm'bed before me this da~ of _ ~~~l i~~1~ ~ i J
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A.D.19~~9 . ~
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~ ROGER _ POI TRAS. CLERK OF G I RCU I T GOl~2T
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~ ST. LUG I E GOUNTY, FLOR 1 OA ~ • ~
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EPUTY LERK '
. 30~~ 3~1,,~~E 5~5 ~