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'F~O THE CLERK OF THE CIRCUIT COURT. 45~~
ST. Lt1G 1 E Cp~y, ~i,O~A; ,
9'his is mJ declaration of Domict~e and Citizenship in the State of Florida that I am 51ing this day in aeeordanx. and•Ia
_ conformity .vith Section 2'12.17. Florida Statutes.
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T I was formers a legs) resident of ~ ~ r ~ ~ ~ 1 1 and I-
c ILtit ) I ~GI~ C 4 ~ C IState)
resided at C • ` C~ It ~ ~ ~ ~d - _ However. I have changed my domin'le to
tStseet and Number)
and am and have been a bona fide resident of the State of Florida since ~u 'Rt° day at
Q S
!9__~_i i, and I reside at oZ. d f ~ r t U M l~ ~ F
n , (Sued and Numberi
. ~ ~ L. t-t ~ C L°, ST . L uC 1 E County. Florida,
_ ttacy) _ ~
and this statement is to be taken as my declaration of citizenship. actual legal residence and don~l~e in the State of Florida.
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IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES
CHILDREN IN S[HOOLs PLEASE STATE PLEASE [HECK:'
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THEIR HAKES: -
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~ ~ r-sa ~~`~-b ~ a ~ 6919 ALA 20 PM 2~ 32
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I FLTRTFiER CERTIFY that 1 w~11 register at my local address 7ahen the registration books reopen. and comply with all
other requirements of a legal resident of this Stan.
I FURTHER CERTIFY that I have no intention to return to m~ former domicile. and I intend to remain in
T. U C I E .County.
_ (Gtyl
r'?arida. permanenti~.
?~~ndrn L.e~ ~o11ES
~S~'
ttiame)• 1
(Address) .
. ~orn ~ and subscnbed before me this day of -bra ~ ~ ~ t-- ~ -
. - - ~ ~ _ ~ 3 y s_
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- A.D.19
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~OG~R POtTR ~ CLERK OF C IRCtlIT COl~2T r~.:p7~~~;;=;f': -
ST. LUGI E COUNTY, FLOi2 )UA _ ' ~o`~`
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