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46'7022
'FO THE CLERK OF THE CIRCUIT COURT.
S~ . L UC 1 E COUNTY. FLORIDA: .
~ This is my declaration of Domic$e and G~tiunship in the Stets of Florida that I am 51ing this day iv aooordanae. and is
conformity with Section 2?2.1T. Florida Statutes.
' I wu former a legal resident of ~~//1 y and I
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resided u Z /~/U~S/ • - Aowever. I have changed my domicile to
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and am and have been a bona fide resident oithe State of Florida since '~3 day of
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- '/i~0!/Lr/tf~~ ~ 19~. and I reside at y~iP/E~(/ ~ '
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S /~r S7 LtJC~£ ST. lUG 1 E County, FJor;ds,
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and this statement is to be taken as my declaration of otisenship• actual legal residence and domide in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOt.~- PLEASE STATE PLEASE CHECK:
THEIR NAMES: ~J
FILED At10 P~ CU:•~t.U
s ROGER
PO TRA5h-
CLgtK C:F.CU1T COt~~T
4+b''7022
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I FURTHER CERTIFY thst I w~71 register at my local addres.+ when the registration books reopen, and comply with aD
other requirements of a legal resident of this State.
I FURTHER CERTIFY th:t I have no intention to return to m. former domide. and I intend to remain in
~ J T. L u C. l ~ County.
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Florida. permanenti~.
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.f (Name)
Sworn to and sn~~efore me this a3 day of • ~T ~U~/F ~ `L
/Uo~eM6e~e " ~ .A_n.19_~_-- - . _ - ~3ysy-
.79 _
ROGER 1'OITRAS. CLERK OF CIRCUIT GOI~tT CS~.~ _ -
- .
ST. lUG 1 E COUNTY, FLOR t OA - -
•
BY: ~ -
• _ EPUTY LERK .
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