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Declaration of Domicile and Citizenship
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45i~iZSO F
ZIQ THE Ci.ERK OF THE CIItCUIT OOURT.
S#.. L UC 1 E COUI~'7'Y. FLORIDA: !
Ibis is m~ .dscLratioa of Domicile and (Stissnshtp is the Stab of I~7orida flat I am iRiag this dy is aeoordaaoa. and is
_ eonfo~rraif,T w[tb Section 222.17. Ploeida $btutes.
I was f
~ a legal resided oI A/GTO/~ /LL s /~/!C h~ and I
(Qt71 - 18eatd ~ s
resided at ~a~ 5~'C W. ~ a M/ G ~ However. I have ebanE.d aQ,T domicile b t
18t~w~t a~ Neeberl
and am and have been a bona 5de resident dthe State a[Florida aiaoe ~ ~//@`' S•C~`'C o ivp
daJd
.~~s~c,~ ~ ~ ~ ~Y ~ %2
.mss vit ~ /sue .v
.1! and I reside at
~o it i L y / lF . ST lUG I Esw.t.ad>~..?.rl
~ conntT Florida.
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and this statemeSt b b be taken. as mT declaration aZ dtisenship. actual kcal residence and domidle is the State a[ Florida.
IF FOR THE PURPOSE OF ENROt.tfNG IF FOR NOMESTEAD~PURPOSESa
CHfLDREN fN SCNOOt., PLEASE STATE PLEABE CHECK:
THEIR NAMESS
X79 Atl6 16 PN ~ 22
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FiLEO A RECOROEO
ST.LUC CQUf1~Y.F~A.
CLERK CIRC
Nt CROAT J
P.ECOR(1 ~'f P.if iEC _
I FITRTHER CERTIFY that I w~ register at m7 local address when the registration books reopen. and eomplT with all
other requirements d a legal resident d this State.
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I F~TRTIIER CERTIFY that I have no iateation to return to former domieiie. and I intend to remain is
_ ~ (Qty) C ~1.
i
Fbrida. permanend;.
/~J~-,AS SA 2Kc_ SiA v
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• ~ J~/2E~J tJ~ /Jc AJ~Jo
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Sward to and sabsa~'bed before me this l~•Ch daT of o~tT' • `UG IE ~GA , 3 3
A.D.19_ 7/ a '
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R A C ERK OF C 1 RCU I T COURT J~-y t
ST. lUG E COUNTY, FtOR LOA _ ~ • v.~ ~ '
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