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466269
TO THE CLERK OF THE CIRCUIT COURT.
S3'. LUG 1 E CO~~y~ ~-jp~A; ,
~ •
~ 4'his is my declaration of Domicile and Citiumbip in the State of Florida that I am Sling this day is accordance. and is
conformity with Section 222.17. Florida Statutes. •
' I was formed a legal resident of Q S ~ ~ U / ~l'ti _ C . -and I
IQt~) . IStaW
resided at ~T ~ ~ ~ ~ ~ 9 / - Aotvever. I have tbanged my domiule to
(Street and Numbs) .
and am and have been a bona Bde resident of the State of Florida since ~ S-T-~-~ 9 ~ 9 day of
19 - and I reside at ~i so ZI ~ ti / ~ ~ f
~ IStred sad Numbs)
F' / ~7j ~ ~C ~ _ ST. LUG I E Connty. Florida,
_ 1(~7)
and this statement it to be taken as mJ declaration of c~tisenship. actual legal residence and domi~e in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOIr-PLEASE STATE PLEASE CHECK:
THEIR NAMES: ~
- F~ /2 &Tti /~t?N ~ tL ~iNSa~
.979 h0'~ t 6 °3~ 2- C 8
f tLfL AMJ 6ti C;. •:.'i:
S~. Lil!'IE C4itiM i Y. f L ~G.
RO6ER PbITRAS
Q.ERR E1R~U:T C~'!~'
4" 9
I FURTHER CERTIFY that I vvSl register at my local address when the registration books reopen, and comply with aD
f other requirements of a legal resident of this State.
i
I FURTHER CERTII~'Y that I have no intention to return to my former domic9e. sad I intend to remain in
j
T. i. v ~ ~ t. County.
_ 1(St~) _
Florida, permanenti~.
:e
•~i~_ .
~ / ~ i ~ i ~Aci
~'~j . (Addr.sa)
Sworn to and snbsQibea before me this ~ day of
R ER PO AS CLERK OF C I RGU! T COURT _ . ~ _ _ _
~ ~ _ _
ti ' -
ST. UG1E COUNTY, FLORIDA i
,t _
BY: ~ - -
• EPUTY -