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- ~ec~aration of~ Domicile acid ~Citi~~~si~ti~-~
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- 456658
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100 THE Q.ERK OF THE CDi~„tJl'r OOURT. :
S~. LUG 1 E Oovl~n'Y. FLORIDA: - ,
~.`c'l~is is ap deebvatioa aI Domidle old ~ is tLa State d Florida tbd I am ~ tbb dq itt seoo~daaoe. iad is
- enaformi<, wltl Seetio~s 222.17. Florida Statutes. ~ _
' I was forme a Iesal resident d ~ ~ !J[ - sod I
- ICIV) t8t+ta1
resided at ~ Aoweves. I bow eLaodsd ~ daenieile to
t a~iNvs,D~e!
aaa am and lave bees a bona sde resident d the 8t}t. d Fbrida aiooe ~ ~ ~ l -3 daj d -
r 19~ and I reside at ~
- 18a..t aed Atosb~
` ST. tUGIE
G ~ Conat~. F7aida,
and this statement is to be taheo as aqT declaration d dtissnsbip. adnal kcal resideooe and domio7e io the State d I~7orid:.
IF iOR THE PURPOSE Of ENROLLING IF FOR HOMESTEAD PURPOSES
CHILDREN IN SCHOOL~-PLEASE STATE PLEASE CHECK:
THEIR NAMES:
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I FUATID~:Ii (~:ATII~'Y that I w~ registcr at m7 loch address when the registration books reopen. and eamplT with all
Ili otter regmrrmenta d a legal :+eaide~ d this State. .
f I FgATHEB 4'Qt1'1>:'Y tbst I Lave no intcntioa to return to formes dom. and I iatcnd to remain in
_ _ T~ LV61E ~~t7.
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~ ~"~a' 19I9 A!~ 29 ~ 1~ 14
~ FilEO ANO RECO~
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ROGER
PO
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aERn cn~cxxnT u~~-
. L CU(//l/~~ RECORD VERIFI~O~-
E _J ~ 456658
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Swastoaad sobetribed betas me this daj d ~GU~C~~~
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Y-- -79
K ~ CIRCUIT COURT -
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ST. LUG1 E COUNTY, 7`'f1:~i~UA -
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EPUTY LERK