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>FO THE CLERK OF THE CIRCUIT COURT. - -
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ST. LUG 1 E CQUNTY. FLORIDA:
9'his is my deeLration of Domict~e and Citizenship in the Stab of Florida that I am filling this dey iio :ocordaaoe. and iA
conformity ~vitlf Section ?22.1T. Florida S4tutes.
~.r I was farmer a kgal resident of ~ / ~1-LQ
r
1 a W ~C1 S• ~ k and I
(Ctt71 lStaW
~ h . ~ ~ - Aoarever. I have changed my domirHe b - A
resided at
(Street nail Numtxr) -
and am and have bees a bona fide resident of the State of Florida since S~ day a[
19_i_ and I reside at ~
(Street sect N I
Q l e rC~ ~ _ ST. LUG I E County, Florida. ~ ;
and this statement is to be taken as my declaration of citizenship. actual legal residence and domia'le in the State of Florida. ~ -
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IF FOR-TNE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHIIDREH IN SCHOOL, PLEASE STATE PLEASE CHECK: - ~
THE)R NAMES:
N:~k; Qh,ne. - S~~.nson, -
~s~~oo -
1919 A!1~ 20 PM ~ 08
Sl!
LUC~COUNC . F A.
_ - - RO(i~R POIT'RA~
CLERK CIRCWT COURT
RECORD YERIf 1EQ
I FURTHER CERTIFY that I wtll register at my local address when the registration books reopen. and comply a itb all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain is
_ T. U C 1 E _ County.
Florida. permanentl;. ~
_ _ 'F~
Y ~
I `~E -
- _ ~ ~i P'~ame)
tAddresa _
~ sworn to sad subscn-bed before me this day of - 'h
. ~ ---9 -
! A.D.19
~ ~1 ~ - _ -
ROGER t'OITRA CLERK OF CIRCUIT COURT
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ST. LUG I E CQUNTY, f LOR t
dY: -
P ~ ~
' E P UT Y J E R K B~K~~Z PAGE~~~
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