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DectG,1:..=ti~~ ~~r~cCi~e end Cctczens~c ~ ~ F
TO THE CLERK OF THE CIRCUIT OOURT. ~~~~8
ST. LUG I E Cpv~Y, FLORIDA:
This is my declaration of Domicde and Citisenalup is the Stste of Florida that I am filing this day in accordance. and in
rnnformity with Section 222.1?. Florida Statutes. .
I was fob a legal raideat of 60 / N ~ P ~ L° and I
lGly) a (State)
resided at . However. I have changed my domicile to i
lstraat aed Nambar)
and am and have been a bona Sde resident of the State of Fbrida ainoe _ y ~ day ~
~p
L/P l P IY7 d P t _ 29?
~ , and I reside at l~ O r_. ~Pa ~ ,~~!/~P .
18traat sad Numbar)
_ n ~ ~P t -P ~ 3 ~ y .S(~ ~ ST . L UG I E County. Fbrida.
lay )
and this statement is to be taken as my decoration of citizenship, actwl legal residence and domicile in the SLte at Fbrida.
IF FOR THE PURPOSE OF ENROt.LING IF FOR HOMESTEAD PURPOSESr
CHILDREN IN SCHOOLr PLEASE STATE PLEASE CHECK:
THEIR NAMES: ~_1
fttLEO AN` ~ ~ +DEO
_ ROGf=
CLERr :.•~URT
Dec 1 Ise PM~'T~
1
4~'~~
I FURTHER CERTIFY that I wi11 ngistei at my local address when the registration books reopen. and comply with all ! `
other requirements of a legal resident of this State. I
I FURTHER CERTIFY that I have no intcetion to return tom former domicile. and I intend to amain in ± `
_ _ U C 1 E County.
ICBM!
Florida. permaneaci; .
1
V'.~~sfi .~y~. ' IAddned
_ ~N. 79
~ ~ ~ ~~S`' ~ G ERK OF C RGUI T COURT
ST. ~ ~ COUNTY, FtOR tU
BY: ~ ,Gli . , - -
EPUTV LERK
SOOKJ~?~ PAf,E~.tr~.W