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.45980 .
~0 T8E Q.ERR OF T~ CDtCUIT COURT. - -
L~ OOiJN'Z'Y. FLORIDA; ~ ~ - _
• ~'TLis is deeLu~~atios e[ Domio'{e and ~ is the State o[ I<7osida that I am ~i tLis daq isaoaoedane~s. and i>a
. eootenmitlr wits 6eetioo ?2Y.17. I~arida Statatea. .
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- . Iwas ~akgalresidaatd sndI
~ ~ a lCW! • _ tti~eaW
~l J /
resided at ~ - However. I Lags c>saaaed mT 8aomies7e is -
p3teeMta~ai>htmala~ -
.and aav aodhave been aboas Sde resident ad tLeSlate adlr'losida aiaoe ~ ~ ~ asy d
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29~ and I *+eside at ~ ~ ~ .
~ - ts~Mtaadl~lamb~
~p _ . ST, LUG 1 E -
.l' ~ t G't-C-l~t,~ . ~ _ _ ~ CanatT. h9orida.
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and this sLtement is to be taken as mT decLration of d~t'ncnsbip, actual legal residence and domx~e is the State d ~7arida.
IF FOR THE PURPOSE OF ENROt.t.ING - - IF FOR HOMESTEAD PURPOSEbi
CHILDREN 1N .SCMOOLe • PLEtZSE STATE _ PLEASE CNECKt
THE 1 R NANE~2
- Fsl9 SEP ZO A~ ~ 28
- FILED a PECOK{~p
SLLUCI CDiil1TY.FLA.
~ ROGEPOITRAS -
- ~ _ - CtER1( CIRCUIT CO ~ Q,,
RECORD ~~ERIFtED_
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n.. _ ~
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I 1:'UlM'~ ~y tbat I wiII tegistet at mT local addreaa when the stgvRratioa boots reopen. and eomplT witb aD _
. ath+er reyuiremeats d~ legal r~ ad this State.
I FURT~R R that I have no intention to return to an former domieDe. and I fiotead tQ remain m
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F7orids. pei
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ac ' : _ ~o
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~P OUNi'I • F~ (N~ma
Swa~esaeaedsoisoci'bedbeto~+ea~e tms elay.~,i -
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K~~`OI''CiRGUIT GOt~tT
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ST. LUG I E COIf~iTY~ Li'Ri 7D~A ` -
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