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X60484
TO THE CLERK OF THE CII;CUIT t;OURT,
ST. LUC 1 E o0Ur1TY, FLOISmk; -
Thii fs'bo,7 fieelaration d Domicile and Citiumhip in the State d Florida that I am Sting thin daT is aooo~d~aace. and is
oonfa~rmitT with Section 2?Z.17, Florida Stat~ut~es. `
I was i~ a legal resident d
_ ItSt71 181,~W
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d / lei/f~~Cl~f~-~ ~ 1~ - Aowever, I bave changed ~ domide to
_ ISte+~t aced Naobar) .
and am and bave been a bona fide nsideat dthe State of Florida since ~m /Sc ~ ~ ~ d
. ~ 7 .19~~ and beside at ~ ~ ~ ~ Sfu~ ~1~ -
_ 18tr..t.od Nomb.el
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and this statement is to betaken as ml declaration of citisenship. actual legal residence and domieRe m the State d Florida.
IF fOR THE PURPOSE OF ENROLLING Ii FOR HOMESTEAD PURPO~ES,-
CHILOREN IN SCHOOL, PLEASE STATE PLEASE CHECK:r y
THEIR NAMESS _ - ~ 1
1919 SEP 27 A~ ~ 40 '
_ ST U
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COUN~Y
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CIRCUIT C As~ ~ ~ Q~ -
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460484 -
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I FURTHER CERTIFY that I w~71 register at mT local address when the registration boob reopen, and eompl~ with all
~ other regmremenU ai a legal resident of this State.
I F'tIRTI~A CER1'I>`'Y that I have no intention to return to m~ farmer domictie. and I intend to r+emaia is
T . U t: l E _ Conntj.
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Flarida. permsneny;.
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Swam to and snbseribed before me this _ .2 ~i dad d ° - `L ~ s~
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ROGER P01 TRAS. CLERK OF G IRGUI T COURT
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EPUTY LERK
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