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----Dectar~fion -of domicile and Citizenshi_P
456544
TO T~ CLERK OF Tl~ CIRCUIT OOUAT. r
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S~ LUG 1 E OOUNZ'Y~ ~,p~w;
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~'Thb is mP declsrstioa d Domidle and Citissnsaip is the Stag of Florida that I sm this dq is aaoordanot. ind is
eoatormi~ wiw Section Y~.1T. FloRida Statdtes. ~
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' I was ~ a 1eEa1 resident d ____.,~P-~~ _ ~ _ and I
t 1 _ ~
resided at Howe?er. I bsw sitaa6ed ~ domidla to
..a
and am and haw bees a bona Sdt tae State dTr'brid: since t / / T ~ ~ 9' dsT d
lg__. and I r+eaide d ~
S ~ i~ p ~ _ ST. lUG 1 E CooatT.~7adda, -
and this statement is to be taten as mT deelaratiaa d dti:easaip.:ctnal Legal resideaoe and domieRe in the State d Fiorida.
IF FOR THE PURPOSE OP ENROLLING IF FOR HOMESTEAD PURPOSES
CHILDREN IN SCNOOLs-PIEASE STATE t PLEASE CHECK:
THEIR NAMES:
C
- ~i9r~~r1/ ~hc~ .1
L-~,~v ~g~s~ 456544
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1919 AU6 28 P!i IZ~ 25 ; -
~T~
LtR;tE
COUNCT1f~F A. -
ROtiER PO1TR/1~
' CLERK gRCWT COU
RECORD YERIFIEp
I FURTI~R ~'Y teat I wDi register at mT iocai address when the registration boots reopen. and oomplT wkh aD
other regtiir_emeat~ of a legal resident. at this. State.
~ I F[JIiTIlER t~EtTg'Y tbst I bs~re m retention to return to iarmcr domiole. and I intend to rrmain in
`~6w _ _ T. UC1E _ ~7.
t
Florida. permanendi
. ~Z & CD~j
s.~ Tglsh?•4
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Sw~sesteaad snbsQibed beiara me tLis ~ daT d _ i~a~"/ ~ G~~A-- Q~~!-~ : t
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ROGER'~I~AS.~CtE'RK~i~~CiRGUiT GOl~2T
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ST. lUG1E GOIAJTY,'~-FL-ORIt
• EPUTY LERK ~ 60
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