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Declaration of Domicile and Ci~ienshi ~
~ ~
. ~ 456441
li0 Tt~ Q.ERK OF 1'AE CDtCUIT OOURT.
S~~ LUG 1 E pp~y~ ~,,O~A;
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~ `'This k aqT dedsratios c[ Dasicik asd Cilaesship is the State oI ~7orida that I sum SHnt this dy is sooordaaoe. and is
. _ oontormif,T wHb Sedlos 222.17. Florida Statutes.
V I was ~ a kgal resident of ~~'O ~ ~ ~ ~ oQi 04 asd I
lCl4) 18~aW
resided st ~ However. I haw ebaaged nq domice~e to
(send aed Hoses -
snd am and lave been a bona 5de sesident d the 8tste d Floridi since ~1 d
~ ~ /3 J ~ .q vEtiv E Z
19__. and I reside at
(sued and I~omb~rl
~p rtT ~i~-+2cc= _ ST. LUG I E Co~mt~r. Florida.
tcls~
and this statement is to be taken as m7 declaration ad citisenship, actual legal residence and domieale in the State d Florida.
IF FOR TNE_PURPOSE OF ENROLLING ~~hF'FOR NOMESTEAD PURPOSES,
CHItGREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
TNE1R NAMES:
~oSi-~~L. ~ ~4RC~-J
1979 AUS 28 11N ~ 20
FI~~,E,~~O
A~~NOppR~~EC~EO
ST~06ERCPOITTRA~~ ~
CCERIt CIRCUIT
RECORO VERIFI
- ~ 456441
_ _ - _ _ _
r
I FIJRTIIER G~RTTFY that I we11 register st m~ bcal address when the registration books reopen, and eomp~ with aD
otter regfl~~ta d a kgal reaide~ of this State.
f I >:'tJR1'IIF:H CEEtTII~R that I have no intention to return to m7 former domit~. and I intend to remain in
_ JT . LUG 1 E _ Countj.
~ _ t~l)
nili
€ ? o!T/~2
savors to and:n befoa+e me this Z ~ daj of F6 i2T ~ ~'~G~ .
I _ _
ROGER PO1TR/l5. CLERK OF G IRCUI T GOU2T ~~eJ~,y1auF ' ~
ST. LUG 1 E' COUNTY, i'LOR 1 DJ1 - , ~ ~ ~ .
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A C a?IF~ ~ f M .
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