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45"x443
FO T~ Q.ARK OF T~ CIRCUIT COtJ1tT.
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5~., LUG 1 E ~ oOVAI'!'Y. FLORIDA; .
~;~'This b ~ deelarstion d Domie,le and Qti:easbip in tl,e State oI Florida that I am 81ins this dq io'saoardanee. and is
. _ eonfarmlb wlt>a Section 222.1T. Florida Statutes.
_ • ~I was fa~ri a Legal resident d ~a~~~S ~c° _ ~7 . { _ Q ~ n g and i
~Q 1C1~) ls~•i
resided d / • lJ • ~X - flowerer. I have changed ~ domic>~e to
(Strd aaa I+lomber)
.and am and have been a bona Sae mident of the State dF7oriaa atnce dad d
~ ~ ~
- 18._.~. and I reside at fo?l S• o~ 02.
. 18tr..c..al~.mD~--T
,L'4''~ e~/ ST. LUG 1 E ~~.~;a,. •
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and this statement is to be taken as ao~ derLratioa d citizenship. actual legal resiaeaoe and aomial~ is the State of Florida.
IF fOR THE PURPOSE OP ENROLLING if FOR HOMESTEAD PURPOSES
CHILDREN"IN SCHOOLr-PLEASE STATE PLEASE CHECKt
THEIR MANES:
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1
-J'S.
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t
I F'tIRTI~R L~TII~'Y that I wdl register :t m7 local address when the registration books reopen. and oomplT with aU
other reQniremmts at a legal resident of t>~is State.
I F[1RT1~ t~tT11:'Y that I have no intention to retwn to mT former domi~e, and I iatena to remain in
- - T U C 1 E , ConatT~
_ latj) .
F7ariaa, permaaend;. .45'7443 -
1979 SfP -g P!i 2~ 28 _
- - F!!ED AND FECDRdFO -
ST.LUCI~~COUNT .FLA.
- _ CLERK CIRCUS
OAST .
i~CORO VERlFlEp
• - 7~ 1 So Soya s r'..4~r. a
s..ers toad sabeaibed befa~!e me this dg o,{ ~rz~'" ~j t-72crE ~L.. 3 3 `/S~
R K=~F'GIRCUIT COURT - ~'-``-'""ttf''' ~s.'~,.. ~
ST. ~UGIE COtA~iTY,--FLZIRIQA - 40~~.~ ~~,xi: -
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