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i~0 ZiiE CLERK OFTHE CIRCUITCOURT, - •
_ _ St. 1.. UC 1 E Cotn~t, F1.oRmA: ~ -
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` ; `t'his is my declaration of Domic~7e and Citizersbip in the State of Florida that I ara Ming this`da'y inn `ac~cor3ance, and is '
_ r~~afurTnity aitb Sectioa `r22.1T, Florida Statutes. Cha~es~ n W v
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I rs formerly a 1ega1 resident of _ - _ ~d j
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rYS ~ded at Hov+ever, I have ebangrd my donvu7e tP
(Strscl. nail N
r~ d ~ m and have bren a bona fide srsideat of the State of Florida since dsy all
- _ _ - -19 _ nail I reside at ~ ~
• ~ S L_ - ST . L UG i Es "o° umt~l
- - Count, Florida.
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ar.3 this statement is to be tzkea as my declaration of c3ti2enship, aduaT 1ega1 residence and domia'le in the Slate of Florida.
IF FOR THE PURPOSE O_F ENROILtNG IF FOR HOMESTEAD PURPOSES, .
CHILDREN IN SCHOOt., PLEASE. STATE PLEASE CHECK:
7HElR NAMESS
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I : [i:ti':i~:tt Cam= 'fI:'Y that I ~:al r~~is!er at r,.y lo:::l ~ddcess tihea the registration boo4s reopen. snd co:rply ~::t5 Ell
r:;gci.-c~:.cats of a legal resident of this State.
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j I •r URTH£R C~'RTIFY that I have no inixntion to return to my loaner domicile, and I intend to remain in
- - _ _ _ . T . U C 1 E .County.
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~2 i--~~I_ ~~~S,~_ CLF_~K _nF CIRCUIT COLT
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