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Ueclara~ion of domicile and Li~izenship
zoo THE CLERK OF THE CIItCU1T COURT.
S'~-. LUG 1 E o0vtv't'Y. FIARIDw: ;
3 This is ~ daelaratioa of Domicile and eaship in the State of Florida that I am !fling thb d~ io aaootdaaos. and is
ooatormiftij witb Section 228.17. Fbrida Statutes.Q ~ n -
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I was tarme~r] a kEal:esWent o[ - and I
~o~ S 57~ ~ ICRS) 1
resided ~ ~ -However. I have ehaaEed m7 domicile to
lStrMt+rd Htsb~rl / Q
_ and am and have baea a boon Sde resident of the S4te at Florida since ~=.~.L -dal d
19_._. and I reside at
ST, lUG 1 E Connt~.
~QV~
and this statement is to be taken as mT dedaratioto of citisenship. actual legal residence and domiefle in the State at Florida.
IP fOR THE PURPOSE OP ENROLLING IF FOR.HOMESTEAO PURPOSES,
CNIIOREN tN SCHOOL., - PLEASE STATE _ PLEASE CHECKS
THEIR NAMES:
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' 19T9 AUG ~ 3
~ 2~ 20
FILEC OpR~EC
S~0(iE~CPOfTRA~A.
- CLERK CIRCtRt COURT
RECORO VERIFtE0
I F[TRTHER CEIt1lFY that I w~ register at mF local address when the registration books reopen, and oomph with aU
f other regnirements of a iegai eesidani of ibis Siaie.
! I FURTHER CEIt1lFY tbst I have no intention to return to ml tormer domic~e. and I intend to remain in
C E Countj.
Florida, perinaaend;
. ~ CoUNTr '
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V N1 ~ -
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E COUMt't•~~
Sworn to and snbsalbed before me this daT of 3 3 T S
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A.D.19
~ ~1
R AS LERK OF CIRCUIT COURT
ST. LUG i E COUNTY, f 1..OR 1 DA
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BY: -
• EPUT t.ERK g!l~K~~4 PAGE141Q•
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