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Declaration of Dort~icile and Gitizen~hip t
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• 454414
700 THE t~.ERIC OF THE CIRCUIT COURT. f
S'~• lUG 1 E
• OOUNTY. FLORIDA:
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~ `;'lbis M ssT deelarstbn e[ 1)omie~e and t`.~tuieasoip to the D'tste N I•'>torida tdat I am )taint ttis da,T in aoooroanoe, sea im .
. _ eontorssiW? ~ Section 222.17.1:7orida Statutes..
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. I was former 'a legal resident d ~ r~G/~ ~i `c ~t~ _ Z and I
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resided ail l ~ ~ _ ~/Vc~r:y ~_,~S~~o d ~ - However. I bare chanted m~ domie~e b
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and am and have been a bona fide resided d the Stab at Fbrida since ~f dy? d
.19.~. and I reside at 1 d ~ j4n~ Y ~A NC' -
1 and NrsDar)
~'c~ ~t c ~ ~ ~ ST. LUG i E ~ Co~mt~. Florida. €
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and this stateme~ is b be taken a}.m7 dsc4ntion of eitisenship. actual legal residence and domicile in the State d Florida.
IF FOR THE PURPOSE O~ ENROLLING If FOR HOMESTEAD PURPOSES,'
CHIt.OREN IN SCNOOt., PRASE STATE .PLEASE CNECK:
THEIR NAMES:
~AG/ At ~O QG Z.
.~~A NNO/? ~ ~
1919 AIlG -9 1111 11~ 31
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R08ER POI
. /l'c ~ c' ~ L A ~ . CLERK ClRCUIt
• RECORD NERIFIEO~ ~
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- 454414 t
i I FURTHER CERTIFY that I wt71 register at mT foul address when the registration books reopen. and eomplT with aD
other regnirements a[ a legal resident a[ this State. _
I 1•'tJRTHER CERTII~'Y that I have no intention to return b m~ former domieRe. and I intend to remain in ~
_ T. U C I E _ Con~T.
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o ~e c e laa>>
Florida. Pila•-
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~l r' afgq••.,
c~F~OUti1Y ft~P QdaID~)
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Swore b and subscribed before me this daY d . ? c e t' !i4 ,
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A.D.19
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ROGER P017RAS, CLERK OF CIRCUIT COURT
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ST: LUG 1 E COUNTY, f tOR t OA
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BY:
EPUTY IERK
- ~ • 314 P~ • $04 _
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