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'100 TSE CLERK OFTHE QRCUIT (70URT.
S~-. LUG i E OOVN'1'Y. FLORIDA: .
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~ `~'Tbis is ~ dedaratios a[ Domica'la and (~tisenshlp is the State at Florida that I am ~ this dp is sooordaooe. and is
. _ ooaiormit~ s~ SKtioa ?•?S.1T. Florida Statnt~. -
' I was a legal resident o[ ~ T. ~ .o t. D IR b R L ~ ~ ~
L ~ and I
ICty) . Iseatd
resided at ~ ~ C ~ d
l) ~ ~ 12 it - However. I Lace changed s+q domiea7e to
ISt~.d and I~insib~rl
sad am sad have been a bona Sde resident d the S4te e! Fbrida ainee ~7 ~ _
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i i! ' ~ ~ and I resids at ~ ~ ~ S- ~ , d~..4K ~ W IO R S T ~ R
18a..c..ahl~b.r1
fir: S T_ Gib ~ ~ - ST. LUG I E cooatT.lc7a~ida. .
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. and this statement is to be taken a, m~ declaration o! citizenship. refuel kgal reaideaee and domiale in the State d >`7orida.
IF FOR THE PURPOSE Oi ENROLLING I FOR HOMESTEAD PURPOSES
CHILDREN IN SCHOOLr-PLEASE STATE PEASE CHECK: _
THEIR NAMES:
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. ~ X919 ~C 28 All S 39
ST~IjC~ REIt11S~
61.EA1( C1RCU[T COURT
- - ~IFCQRt YEWFtED__S,
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I FI)R'1'HEK (~'IZF'Y that I w~ register at m~ !Deal address when the registration boob reopen. and oomph with an
other ssgnirements o! a kgal resident o! this State.
i
I F[JRZ'l~R CEKTII''Y that I have no intention to return to m? iora?er domicile. and I intend to remain is
T. U C I E _ CountT.~
_ l(~71 -
Florida. permaaend;.
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Y;J. -.ry I
•.4 ~ ~ ~ 5 t,L~ .L Ak ~ N- v its ~ ~ tz
swar.to _ ~ "~s~ me tba ~ d,~ of V~~sr~r ST. L ~ci e
~ce,H6r1~. ~ - .A.n.is_--- - f~~ zder~ie/C ~o~Nisch
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ROGER FOITRAS, CLERK OF CIRCUIT GOt~2T
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ST. LUG I E COUNTY, FLOR 1 W?
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_ E P UT Y L E R K nni~.~G - ,