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4994'7
'FD THE (.ERR OF 1'HE C.IItCUIT OOURT.
S~~ LUG 1 E OOVrn'Y. b-lpitIDA; .
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`1'h)s ~ m, declaration ai Domic~e and Qdi:easbip is the State d Florida that I am 5>'ios this dy is aooorda~oe. ird is
_ aonfarmttT with Ssdiaa ??2.1T. Florid-a~Srt'ataUs.
- I was i~ alegal resident d 1 ~ //a~o/~ a ~ Tun and I
7 ICk~) . 19e+ta~)
resided d ~ ~ c ~ l Nod ~ ~ aim ~ - Aowever. I have ebaoaed m~ damiu'M to
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and am and bavebeen abona Sderesident ofthe S4te oiFlorida since dsF d
.19~ Z• and I reside at '~~a C~e /7 C.~ .
18a+••~ aed I~iomb.rf
.ST Lvc ~ ~ e ST. LUG 1 E ~h,, F-~.;da, ~
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and this statement is to be taken as m~ declaration of dtizenship. actual legal residence and domicile in the State ~ Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES, -
CHIt.DREN IN SCHOOL, - Pt.EASE STATE PLEASE CHECK:
THEIR NAMES:
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f11lED ~N: , ::3ED
ST.LUCtE 1 ~ RA
RECO~'
OEC 18 3 5~ PM ~
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- 4994'7
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w I Fl.TBT~ CQtTg'Y that I w~ register at m~ loch address when the registration books reopen. and eompl~ with all
other requirements ai a legal resided d this State.
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I FURTHER CER1'lF'Y that I have no intention to return to mF former domic~e. and I intend to remain in
i ~ i. ,P T. U C 1 E , Cipuntl.
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Florida. permaaend~. ~
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Swam to and sobassrbedbiYose me this ~ g daT d V o k T ST • d
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L V ~ C , • r A.I~.19~ • ~ A ~ /V C~ • A /V a y i
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ROGER POITRAS, CLERK OF CIRCUIT COURT
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ST. L UGJ E COUNTY, f LOR 1 OA -
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- EPUTY LERK g~~{~ P~~~ -