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declaration of Domicile ana ~.?«zensh~ i
45'734`7
TO THE CI~RR OF THE CIRCUIT COURT.
5~~. L UG i E OOUN'1'Y. FIARIDA: .
. .
~ `;This is m,T deelaratioa of Domie~e ana Citiuaahi in the State eI Florida that I am Elias this d~ in sooordanoe. and is
conlormit,T witb Section 2?Z.17. Florida Statutes.
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I was i~ a legal resident of ~ I
/~d~s However. I have domicDe to
re:iaed at 3`3 ~ T"~ OiL ~ teh:asad ms
l3treet and NnaeD~r)
_ and am and have been a bona 5de resident ottbe State atFlorida since dad d
19~. and I reside at ~ ~ ~ J~~
'~/1 . t8trMt cad N~bad
,a ~i~~h2~ - ST. LUG i E Connt~, Florida.
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and this statement is to be taken as mT detLration of otisenahip, actual legal residence and domia'!e in the State of Florida.
t
If FOR THE PURPOSE Of ENROLLING ~If FOR HOMESTEAD PURPOSES,
CHI~OREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMES:
_ _ . X19 SEP -5_._P~__2~ S9. _
` F ~D AND RECTORDfLO
5~~110sER
~TRASA.
r CLERK CIRCtIR C ~e.U
RECORO VERIFIEO_
- ~ ~ 45'734'7
j I F'[JRTHER CER1'IF'Y that I w~71 register at m~ loin address when the registration books nwpen. and oomph with aD
other requirements at:legal reside. aI this State.
~ I FUATHEIi CERTIFY that I have ao intention to return to m~ former domie~e. and I intend to remain in
T. U C I E . Countj,
° _ lC~ts)
Florida. permanenil;
.
BOUNTY
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Sworn to cad snbsm'bed before me this dad of
- ~ - -
• A.D.19
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ROGER POITRAS. CLERK OF CIRCUIT GOl~2T
ST. LUG i E COUNTY, FLOR t WI -
• . ,
BY: , S
_ EPUTY LERK A i
~ _ BUO~J~~ P~E~~~
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