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'f0 THE CLERK OF THE CIRCUIT COURT. .
ST. E UG-i E - covlvTlt. FLORIDAz .
This is a4l declaration of Domicile and Citizenship in the State of Florida that I am filing this day in aeeordana, and is
conformity with Section 222.17. Florida Statutes.
I was fob a legal resident of i~r~ - ~ ~ - and I •
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resided at ~ ~ D ~ ~ D l1t. ~ A . (,D S ~1 _ However. I have changed my domicile to
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and am snd have been a bona fide resident of the State of Florida since. - ~ Y1 ~ ~
V .,1 ~ da7 ~
19 ~ 9 _ and I reside at ~.~~c$~f~~` ~
P - tstrr.c.edNambs) E
~ _ ST. LUG I E County, Florida,
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and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State of Florida.
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Ii FOR THE PURPOSE OF ENROLLING IF FOR NOl4ESTEAD PURPOSES,
CHILDREN IN SCHOOI.a PLEASE STATE PLEASE CHECK:
THEIR NANES~
. _ -1919AUG21 AR1~24
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I FURT1iER CERTIFY that I vn71 register at my local addmss when the registration books reopen, and comply with aU.
other requirements ai a legal resident of this State.
I FURTHER CERTIFY that I have ao intention to returo to my former domicile, and I intend to remain in
. T. U C I E _ County,
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C Florid:. permanently.
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_ l~~~;l/:at!t:z•t` (Address)
Swosatoand snbsrnbed before me this ~ day of 4 0.-
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A.D.19_ ~1 .
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ROGER POl i"RAS~_ CI:ERK OF CIRCUIT COURT ~ ,
~ ST. LUG t E COUNTY, FLOZ 1 OA .
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