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45~`~.31
TO TNE CLERK OF TIiE CIRCUIT COURT.
ST. Ll1C 1 E covr»t. ~Rin~: .
This is m~ declarstion of Domic~e a~d Citizenship in the State ot Florida that I am filing this da~ in accordanee. and ia
conformit~ vrith Section 222.1T. F7orida Statutes.
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I was for•nerl a legal resident of ~ - and I
l9 U ~ L'' ~~c~) Iseatel
resided st . However. I have changed m~ domic~e to
(Stred and Numbv) _
and am and have been a bona fide resideat of the StaLt of Florida since .~U C day a~
.19 7 g_ and I reside at ~ 3 ~ S U' ? f~ L V L •
_ (Stmt and Number)
O~ f ~ t~ L~- L _ ST . L UG I E Coant~, Florida,
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and this statement is to be taken as my declaration of citizenship. actual 1ega1 re~idence and doauci7e in the State of Florida.
IF ~OR THE PURPOSE OF ENROILiNG IF FOR HONESTEAD PURPOSES~
CNIIDREN IN SCHOOL~ PLEASE STATE PLEASE CHECK: ~
THEIR NANESI -
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;~'g 19 f:' 3~ C4
F~~EC aac Y?. ~,t,~i~:u
s ROGER P01?RAS~
CtERK Ct~CUl7 CQU~
Frc.~o ;.F.: g _
' 45~.231
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I FURTHER CERTIFY tAat I will register at my local address when the registntion books reopen, and c~ -nply with all
~ other requirements of a 1ega1 resident of this State. "
I
~ I FURTHE~ CERTIF'Y that I f},ave no intention to retarn to my former domic~7e, and I intend to remnin in
~ _ ^~'t'i~C- u~%!_J T. l. U G 1~ COl1nLy.
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~ F'iorida, permanenti;. -
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Sworn to and subscn~~ed before me this ~ dsy of S T• A
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T - - . A.U.19_ ~1
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- ROGER P01 TRAS, CLERK OF C 1 RCU I T COl~2T _ ' y?'.''l,;
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E GOUNTY FLOR t OA ~~sy~~'~"~
ST . L UG I , . ~ . r~ , a'~'.~'~', .
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~ E P UT L E R K ?~;5; , j,~ ~ .
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= ~ B~ 3~.~ P~.~E 152 _ . . . - . . _ . ~ .
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