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~ T'~ (~.ETUC OF 1'lIE CIIiCU1T OOURT. -
S'f~. LUG i E ~pUNTY. ~,pg~A;
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~ `;'This is ~ d.ehtiratioa et Domicils and Qtiseas6ip is the State d Florida that I am ~ this dq is sooordaaa. and is
~___sa~ ert.... 979 79 F1w.S.1. 5:1.l..~~. 3
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~~~~2~/~L /1~.~ and I i
- I was i~ a k=al rnideat d
t 1. IseaW
resided at l
~ 0 0 ~ ' ~T - Aowe~?er. I haw rhaaged aq domiole to
ttitr.~t and Nmbel Ty
and am and haw been a bona fide resident d the State d Fbrida since dad d
19~ ~ . and I reside at ~ /T !yam . ~ !~/LL/~ DEL ~L ~
(Beset sad Ji~besl
Fi~'s? ~i,~ ST . LUG 1 E -
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and this statement is to be taken ~ m~ declaration of eitizenahip. actual legal residence and dominle is the State d):7orida.
If FOR THE PURPOSE Of ENROLLING If fOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOI,-PLEASE STATE PLEASE CHECK:
THEIR NAMES:
~^'t 19T9 0!'C 28 PN 2~ 13.
FIL~EUOCAh C PECOKUiU +
S ROG LEER
PO~ITRAS A-
- CLERK CIRCUIT to
RECOItg VERIFIF.Q,
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- - - 4'70901 -
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j I FUATA>~ CF~T>F'Y that I w~ register at m~ local address when the registratka boob reopen. and oomplf with aD
~ other regoirements d a legal resided a[ this State.
I FURTBEIt t~R1'1T'Y that 1 have ao intention to return to mf former domicile. and I intend to remain in
r
- _ T. U C f E Countg.
l(it~l
Florida, permaneatt~.
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~~courrry i - - ~
~ - • - //OD-~ /~~itH.a~~~ l/~<<~.f~' .MFG Sio1 3~ F
' Sworn to and snbsar'beiare me this g dad oI _ ?~-~.SF~?„~F 9~/~
~ ROGER POITRAS. CLERK OF CIRCUIT COURT Jo ANN C`'~K
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ST. LUG 1 E COUNTY, f LOR 1 OA _ ~ - ~ ~ '
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~ - EPUTY LERK .,..(iR~77 ____c~i~n -