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Declaration o~Dornrcc~e a~c~ ~c~~zens ip
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S~~ LUC ! E ~ OOVNTY. FLORIDA: ,
~ `,'This i, a~ declaration d Domicile and Qtisenahip is the State et 1;7o~rida that I am ~ this dq ;a aeooedaooe. and b
. _ ooaformlf~ witD Section 228.17. Florida Statutes.
I was laemer ~ a legal resident at and I
I~eyi
resided a# "~.l.~ 1~.. ~o~ c- S n t~ - Aowsves. I haw clanged aqT to
t8t~«e and Nooberl
_ and am and love been a boas Ede resident d the Stale d Florida since _ ~ ~o~ ~j ~
.1S 1~ - and I reside at A ~'~'F-
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(ev~..e..aN..1.i
~ c~ ~ _ ST. lUG 1 E . Conaty, FJarida.
and this statement is to be ta><ea as ~ declaration oI aitisenship. aetaal legal residence and domieDe is the State d Florida.
Ii FOR THE PURPOSE Oi ENROLLfNG IF iOR HOMESTEAD PURPOSES,
CHfIDREN IN SCHOOL,•PLEASE STATE PLEASE CHECK:
THEIR MAMES:
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1 ~ 1.1fti~czr n-==
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I FtJBT~ (~ttTg'If that I w~1! register at mT bnl address when the registration boob reopen. sad oomph with aD
other regoimmeats d a legal resident d this State.
j I I'fJR'1'l~i;A (~ltTg''Y that I have no intention to rettun to m7 foraxr domics~e. and I iat,end to remain in
_ tQsj) _ •
Florida. persoaneatl;.
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Swas to and sabQibed befo~+e me this daT of ~~e ~<~e e1 `=tee ~ . ~ `Q
K CIRCUIT GOI~tT ~ I ' '~5~+,~~i ~ ~ ~ ~
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ST. LUG 1 E COUNTY, FLOR 1 QA - ~='c
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