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~~[~eclara'~or~ oY i~ornic:ile end Liizens~~ip ~
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zo01~ Ci~RK OF THE CIItCUIT OAURT. _ ~~:~93
S'~s lUC 1 E OOUNTY. Fi.ORIDA: .
~ ` Thb b ~ declaration et Domica'l~ acct t,`Itisensbip is the State o[ >c7orida that I am lii)iog t>iis dp is aooos+daaos. cad L
eoatormit~ with Seetioo 22Z.1~. >E7orida Statutes.
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I wa: i~ a le`al raideat al ~ ~ ( _ cad I
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resided at~ ~ flowerer, I hays changed ~ domia7e to
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and am and haw been a boas Ede resident oithe State oiFbrida since da,~ d
19~ I rude at ~
- tlltrMt cad
K . ST. LUG 1 E Connti. .
and this stateaxnt b to be taken as m7 declaration of citizenship. actual lesal residence cad domi~e in the -State d Fbrida.
IF FOR THE PURPOSE OP ENROLLING IF~FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
TH //N--AMES:
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RECORD YER
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I FURTHER CERTg'Y that I wIIl register u mT local address when the registration books reopen, cad oomph with all
other requirements of a legal resided of this State.
I
~ I e ao igteatioa to retarn to mF former domic~e. and I intend to rennin in
I
C E Count.
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Florida, permaoendi.
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Sworn to and bei~asme this daT of s
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.19.79
ROGER P011RAS. CLERK OF CIRCUIT COURT
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ST. LUG 1 E COUNTY, LOR A _ -
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. BY: ~ _ BU~J~4 PIIG~~."" s
E Y LERK
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