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Declaration of Domicile a~rid Citizenship ~
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~o THE c+I.~RR ol* THE CIItCUIT COURT. .
S'~, lUG i E COVI~I'1'Y. FIARIDA:
~`~'l7iis b ~ deeLratioo o[ DomicDe and Citi:ensbip is the 84te of Florida that I am ~iag this dy ia.sooordaaoe, snd fa
. _ cootarmitj wKb Settion ~2t.iT. Florida Statotas. _ -
I was f
~ a kSal resident. oI ~I'~~'~o ~X - _ ~ y and I
,c ItRal 18tat~
resided ~ ~ 7 C/jAV1/~? ~/r~a^~+ - Aowever. I Iuve changed aqT domicile to
T- tsse..c and Noe0sel
and am as~d have been a bons Ede resident e[ the State at Florida since ~G 3~ ~ ~7 d -
crv /v .1gL_.. and I reside st •~6/ ii/.'.E' f/~e.flQ. DAP.
ST ,C4c ~ e. _ ST. LUG 1 E
tct~l
and this statement, is to be taken as aqT declaration of eitisenship. actual legal residence and domicile in tbs State et Florida.
IF FOR THE PURPOSE OF ENROLLING If~iOR HOMESTEAD PURPOSES,'
CHILDREN IN SCHOOL, PLEASE STATE PEASE CHECK:
THEIR/NAMES: ~
~U! Q.r g ~epl~/ Sf Q~Qu /i ~i~
SJ'iCa. Qe ~eo^J 1919 AUG 10 AM I1~ 58
FILED A~ RECOROEQ
UCI Y.f A.
CLERl1
GRPCUa1T
' . RECORD VERIF{EO
45456'7
I FURTHER CF.It1'>F'Y that I wQl register st mT loesl address when the registration books reopen, and oomph with aD
other regnQements et a legal resided of this State.
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I F[1R1'AER (~:RT1F'Y that I have no intention - to return to mp former domir~le. and I intend to remain in
_ T. U C 1 E _ CauntT.
_ ll3tj)
Fbrida. permanend;. -
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3 ~ NF F~~rReJ lQ, ,wit
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Sworn to and sobeesibed before me this _~l d
~ daj of IoiC ~ s~ ~u c / 1; . '~3 y'~°2'
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_ iiii~tis,.,,;,
R A ERK F CIRCUIT COURT ~
ST. BUG I E COUNTY, fLd210A v~ - 5. _
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