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. 45~S821
'~.0 THE CLERK OF THE CIRCUIT COURT. •
S~'. L UG t E Covx~t, F'IAFtIDA: .
:`I'bis is my declai•atioo of L>>mic~7e and Citizenship in the Slate of Florida that I am filing this day is .accordance. and in '
crrformity scitb SectionL22.17, Florida Statutes.
I wrs formerly s Iesal resident o! _r • s - ~'~b~i~i and I
~i ~(Gyt~) ISt:td
rr ~ icird at _ ~ ~~ol~ t e ~ However. I have changed my dousic~e to
r d zm :nd have bc-En a bona fide resident of the State of Florida since 1 di7 ~
_ n ~ _ 19_?_x__~ and I reside at ~i~~~rG
(Sure: aadNunsbal
_ f,.. ~«c~ ST. LUG I E CJODAt7, Florida.
_ fL~t7)
~d this statement it to be taken rs my declaration of citiaeaship, actua] legal residence and domic~e in the State oI Florida.
IF FOR_THE PURPOSE OF ENROLLING IF FOR HONE5TEAD PURPOSES
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKt ~'J
THEIR NAHESS ~l / J
- t '
.
- 1919 AUG 21 PN 2 43-
ST~E06ER
P~TR SA•
txERl(c~acutr count
RECORO vERiF~Eo
I c lilt"i'i: C:-:2~i Ie Y that I ::~11 reb:str; ~t r ~y 1o~J :_ddress tihen the registration basks reopen. znd co:
rplp F:;th all
~:'1,~_: requi.-~er_,ents of a legal n;sident of this State.
1 i'URTH£R CERT'I>:'Y thzt I have ao intrntion to return to mr former domicl7e, .znd I intend to remain in
- _ T. L U C 1 E County,
- ic:yl '
I
~ovrrry
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f
~ , ~ /G7ir13e~i
~~~r--~____ - -
t::L.~e)
' ~ _ dan.,l
' ~ ;.;.3 s ~3 . -r~•= tl b-:;,Inrc me this ~L____~ d :y of _ it/~- L _
- ---------A.D.79~ ~
k
h,~l: ?,',5,~_.c1=F=~K__nF CIRC?JIT COIs~T , _ .
'~~f. t_I.YLlk CO':~~TY, ~LG:2 - -
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