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100 TAE CLERR OF TAE CIRCUIT COURT.
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S'F•. LUC 1 E COUNT9f. FIARIDA:
~:~'!'bis is ap declaration d Domica'k and CftSzeaship in the State d Florida the I am i1n~ this da, ia•aooo~+dane~e. and is
- coatotmitJ with Section 222.17. Florida Statate:.
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' ~I was i~ a kEal resident d aad I
raided at j man - Aoserer. I bare ebanaed nqJ domicile b
ltitrsd. aad Haomb~
and am and have been a bona Sde resident ostbt State d Fbrida sinet~_., daj d't
~ - 19~ and I reside at v
ST . l UG 1 E ~;d,. .
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and this statement is to be taken ~ mJ declaration d citizenship, actual kgal residence and domici~e in tha State d I•'iarida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOI_r•PLEASE STATE PLEASE CHECKS
THE R NAMESS
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a
I FiJItTfIER G1;Irr1>!'Y that I w~ register at mJ iacal address when the registration boob reopen. area complJ with sn
. other regaunement: d a legal resided od this State.
I FIIRTI~R (~ItTII~'Y tbd I love no intention to return to m1 former domicRe, and I intend to remain in
G E Conntj.
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Florida, pera~anend;.
.45'7444 -
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f~ E_~D AHG R.CUn~?f U
S~C_tlC1E COUNTY. FtA .
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RECORD VERif IED_~~~ ~ -
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Sware to sad saba~'bed befoa+e me this ~ daJ of c , e ~ ~P
• A.D.19:~ y 1
R K''DF "C 1 RGU t T GOU2T ~ ~ '
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ST. LUG 1 E COlMTTY, 'FLat~D~1 `t~ ' ~ -T; 15
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