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Decla-ration of Daces-iciie any t~?~?zenship
- ~ 456800 -
700 THE Q.ERR OF THE G'DtCIJ1T OOURT.
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S~•. LUG 1 E OOUNTY. l-1,pItIDA; .
~;;'Tttis is ap deeLration eI Domicfle and (~tiaens4ip in the State o[ Florida that I am ~i t1,is d~ is aooo:daaoe. and is
_ coniormi4 witti Sedioa 2?Z.17. Florida Statutes.
I was f
~ a legal resident eZ ~N~t~//+S ,,,r ~
N~/.p• and I
pawl tBtaW
resided at ~ l • ~A°A~' u -However. I have cDanged aq~ domiti'1e b ~
t and Itsbed
and sm and have bees a hour fide resident of the State e[ Florida sins ~ daT d
19~ and I reside at f w ~~!~e
Ba..c..dllrmb.d
>~~,P~ S~ .~vo~ ST. LUG i E ~ti.
tt~y~
and this statement is to be taken as mT declaration o~ dtisenahip. actual legal residence and domio7e in the Stab a[ Florida.
IF fOR THE PURPOSE Oi ENROLLING ~ If iOR HOMESTEAD PURPOSESe
CHILDREN IN SCHOOLa PLEASE STATE PLEASE CHECKL
TN~~ETTIR NAMES: ~
= 4 v~AN~?~ ~Cc°NE'r /CMG /06.r
- - L,P;,~ seo~f .f~.P~-.~:r ~ AUK 29 PM ~ 58
19i9 p~,
Sfq,Ep_ E~~YT1o1?.
t~~
~R~1 Cp8
4800
I FUATHF.Ii CERTffY that I will register st m7 foul addrees when the registration boobs reopen. and eomplT with aD
€ other requirement d a legal res~e~. of this State.
i
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I FtIRTI~A (:EEt1'1F'Y bat I have no inteat3on to return to m7 former domia'le. and I intend to remain in j
J T. L U C 1 E ~ ~7.
k - lG~t~l - - - -
Florida. permanemli
~bN~
c
V •G
• Q _ ? 7p
. r• G I
~ -
E i11dd++ed
&wors teaad sgbeesa'bed before me this ~ daT o[
r - ~ .
•i ~ ~ - - - A.D.19; 19 -
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R - G IRCUI T COURT
ST. 1 E COUNTY, FLOR 1DiA -
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' EPUTY LERK '
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f ~ - BOOi~~~ .~~6E~.JJ~
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