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Dec~arafian o~ ~Qt111c-ale ant~.'~~~izens - d~
- 45634'7
~0 TNT Q.ERR OFTNE CIIICUIT COURT.
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S~. LUG 1 E _COUN'1`Y. FLORIDA: ,
~`,'lbis is ag dk]arstios ad Do®kilr and is the Stab d Florida that I am •
p this dp is sonordana,
and i.
• ooatormib wkb Sedios 2iCl:.1T. Psorida Statutes. _
r I was ~ a legal resident d ` ~ t /1C d and I
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resided at C/ Rowever. I bags ebagasd mT domieSs to
tst+wt.oa Pte~brl - -
and am and haw bees a bona S~ resident tithe State dFlorida siooe ~ daJ's[ _
I9~. anti I reside at ~
tscr..c
- a~~ ~ ~ ~ ~ `o ST. LUG 1 E
1G4?1 CooatJ. Florida.
and this statement is to be teten as mT dee]aratioti a[ citisenship, adnd legal resideaoe and dom3eDe is the State d I~larida.
IF FOR THE PURPOSE OP ENROIt.INC IF FOR HOMESTEAD PURPOSES
CHILDREN IN SCHOOLa-PLEASE STATE PLEASE CHECK:
THEIR NAMES:
~
I FURTHER CERTg'Y that I w~71 register at m7 local address when the registration-boots reopen, and eomplT witL sD
other rtgairensente d a legal resident d this State.
I F[JRTH~ CERTTi•'Y that I lave no intention to return to former domia'le. and I intend to remain io
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' 45534'7
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Swoe'a to and sabecn'bed before xne this ds~ d
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C K OF' CIRCUIT COURT t
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ST. LUG 1 E COUNTY, f LOR 1 UA - -
BY: - ~ ~
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' EPUTY t.ERK j '
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