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TO THE CLERK OF THE CIRCUIT COURT.
i
ST. l UG ! E (;pU~y, FLORIDA:
Thls b aU? decLratioa of Domia7s and Citisenship in the State of Fbrida that I am filing this day in accordance. and in
oonformit; with Section 222.1T. Florida Statutes. `
.I was former a kgal resident of ~~c~r~ ~P~ ~ R'~C.c~~ Q ~ ~~Ct,nQC1Q and I
(CTt~i 18tatel
resided at S~i~S + art1Q.V t ~ . : ~ _ 1
t~P~_ However. I have changed rep domic~b to
1 gad Number)
and am and have been a bona fide resident of the State aft Florida since til` ~ ~q~ _ day of
19~c1 - and I reside at ~Q~~ Cat` T1QA1 ~ U
-(8ta~it and Nam~ei
~4r~ 'Q~ e~c-r_e, . ST. LUG I E ~h.,.
(Qibi ?
and this statement is to be taken as my declaration ot1 dtiaenahip. actual legal residence and domicfie in the State of Florida. ~
t
If fOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES
CHILDREN IN SCNOOLf PLEASE STATE PLEASE CHECKS t--~
THEIR NAMESS
9T9 OCT I7 29
Ft_Eft Anil FECi~k!i~U
ST.IUCI~ COUH7Y.Fli.,
ROGER POITRAS
CLERK CIRCUIT C[IL'RT
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I FURTHER CERTIFY that I ~ register at my local address when the registration books reopen. and comply with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that 1 have no intention to return tom former domicile. and I intend to remain in
U C ! E .County.
(acyi . , ~ 'P ~ e~c ce
Florida. permanenu; .
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I.i (1..••.. ~
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Swann to and subsrn'bed before me this day of ~
. _ ~ . ~.D.19 79 ~s day ~.o ~
R a ~c tc of c~RCU~T T
ST. LUG t E COUNTY, ftDR t
17
. EPUTY LERK t~'- '
i yy (Q/~
gr,~x• P1?6E - • ~ .mss., _