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TO THE CLERK OFTHE CIRCtJ1T COUAT. -
ST. t.tX.1 E _ COUN'i'Y. ~,pRIDA: -
- d"ee4ration d Dornie~7e and Citiuaship in the State of F'brida that I am 51ia8 this ~ is aOOQ!'~i°0Q• and is
Thin is'1nT
ooniorinIt~ with Section 222.17.9'larida Ststut~es. l ! _
r`?~~ 7/'Y~~~ aadI
resident of J ~ G O if/~ /y
I was forme ~ akgal l~1 ~ ISt.~I
O ~ ~ ~ ~ Aowever. I have changed ap dam' to
reuded ~ - (gt~.at.na Numb•r) d d,,T a[
and am and bane been a bona fide resident of the S4te of Florida sins
r--- - and I reside at ~r~~ ~e ~ -
f~ ~ui 1 IgyNtaedNamber)
~C _ ST. t_l1G l E Count7. Florida.
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and this statement is to be taken as mT decLration of eitisenship. actual kSV residence and domiefie is the State d Florida.
IF POR HOMESTEAD PURPOSESa
If fOR THE PURPOSE OP`EASE`ST/1,TE PLEASE CHECK:
GHILDREH IN SCHOOI~ ~ -
THEIR NAMES: j
-
~t,t:RRtc~RCna~ _
RECORO VERIFIf'n_~~.,r~rs~
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books reopen. and coaopl~ with all
~THEB CERTIFY that I wdl rcgisler at my local address when the registration _
` older requirements at a kgal resident of this State.
I -
former dominle. and I intend to :'emus in 1
' I FURTAER CERTIFY that I have no intention to return to m7T L U C 1 E ~ ~mtT•
t(Sgl _ !
Florida, permanentl; .
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~ _ ~ ri ~ ~ , (Hama) ~ XA
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i Swan to and subieribed before me this ~L-- ~1 ~ _ -
~-0 ~ ~ ~ A.D.19
~ ~ ~ R I S ~ ~ A.S a
~ - 79 \
RpO~ PO { TRAS. CLERK OF G { RCU 1 T COURT
ST. LUG 1 E COUNTY, f tOR II OA - .
BY: ~
_ EPUTY IERK I'~
` - 640K PAGE ~:~Fpli _