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Declaration of Domicile and Citizenship
45006
TO TAE CLERK OF THE CIIiCUIT OOURT.
ST. lUG 1 E opUN't'Y. FLORIDA: .
This L my declaration d DomicDe and Citissnship in the State d Florida flat I am Shag fhb daT in aeeordaaoe. and in
conformity with Section 228.1?. Florida Statutes.
I was i rme a bgal resident c[ ~N ~ C~ and I
t(~C7) (8ede)
resided at~~'~ ~ /~'~-AwT< < Arc APT' S - 3 3 ~F _ However. I have ehanasd mT domicile to
(8tiwt aad N'eD~r)
end am and have been a bona Ede residOe?nt dthe State dFbrida siaa / ~ f dq d
Y 19~ . and I reside at ~~o s N- ~!ti S~ Nb 2~`f'~
l8t~wt ssd N~ba)
~ lac ~ 2c.~ Ft. ST . LUG 1 E Connt~. Florida.
ta4~
aad this statement is to be taken as up decLration d citiseaship. adnal kgal residence and domia7s in the State d Florida.
IF fOR THE PURPOSE OF ENROLLING IF fOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMESS _
~fi~-i ,E.'-c L~ (N i L Sew
~CNNr-ri-+ ~ w,1sd ~~e 1929 A!!6 -T All 11= 11
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~ A.
~}'NA MR2,~ w r f S d n/
~CORB VERI~IEO
454006
I FT7RTIIER C,EIEfIFY that I wdl register at my local address when the registration books reopen. and oomplT with all
other regninmeats d a kgal raside~ d this State.
I
I F'LJA1~iEA CERTIi•'Y that I have ao intention to return tom former domieik; and I intend to remain in
U C I E , ~tT~
laft7) '
s
Florida, permaaend; .
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• _ ~ET/wcrTiY 1/, W~~S Div
*3M~n'OA~' ~ n
Sworn to and snbscnbed beioro me this dal d ~ t~~~AdBesw~ 3 3 ~S V
A.D.19_. ~1
RQCzER P01 TRAS, CLERK OF G IRGUI T COURT
ST. LUG 1 E COUNTY, f LOR 1 OA •
• .
BYS .j
EPUTY ERK
e~`~3~4 P~~E 167 ~ .
AGO Form 71.22
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