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~~Declaration of ~ C~omici~e -and Ci~izenstiip- ,
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S'~. LUG 1 E ppp~, FLORIDA: .
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~'lLis is ay dsd~rat3oo d Demieiis and tl~aeaship ~ tle State d Florida flat I airs lilioE tlis dp is aooordaaae. and i•
. eoatacml4T will Sed3ori x.17. Ffoeida Statutes.
r' I was i mer a IeEal =widest d cad I
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resided si v? ~ Aoweves. I law elaajed noP do®sicRe b
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and amcad lave bees a bona Sde d the Stab d Florida since a" ~ ~7 d
1l.,.~.L. and I reside st ~
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~Q ST. LUG 1 E Connt7. F7a~da. .
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' and this stabmeat is b be ta><en as mp? deelaratioa d eitisensbip. actual kcal residence and domielte in tbs Stab d 1;7oarids.
~f FOR THE PURPOSE Of ENROLLING If FOR NOMESTEAO PURPOSES ,
CHIt.OREN IN SCNOOLa- PLEASE STATE PLEASE CHECK: -
TNEIR NAMES:
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456562
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RECORD VERIFIED
f I FUATI~R (~RTg'Y that I w~7i register at ~ local address wbea the registration books reolreai. and oomph with aD
E other regoiraoeate_d a legal :esidea~t of tLis Stake. - - - -
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~ I FDATIiEB CERTII~R tbst I have no iatentioe to return b m7 former domia~e. sod I iatend to remain in
u C E Coong.
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Swaee b cad sotaserib.d before me tlis 2 ~ dad d (l~-~e- ~ .
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iRGU1T COURT
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ST. Ll1G1E COUNTY, `~.i~ORiQA,E~.~ .
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p - - BOOK Jl5 PAGE~~ .
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