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Declaration of Dom~c~le and Citizenship
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TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E COUNTY. FLORIDA:
Tbis b mT declaration of DomieiM and t~tiaenship In the State of Florida that I am tiRag this dq is aoooedanos. and in
oontormitT with Section 2?.g.17. Fkieida Statute.
I was t
~ a legal resident of vp,Q ~S ~l
c° ~ ~y ~ and I
resided at //H.E'~_d". ~Gt - ~ 8oweve~t. I bavelehanged n4 domicils to
(8er.se awd No6srl -
aad amend have bees a bona 5de rssiderkt of the State of Fbrida ainoe ~L'- • l g~ ~ ~ 7~ - dq at
1 s
~L'C .19_~.andIresideat ~r7'~ J!~/~e~O QG~~ 1 ~
l8tewt sad Nasbul
~oe2~ .S~titi~-f' f ~C i ~ ST. LUG 1 E Conat~.
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and this statement is to be taken as nU declaration of eitiaeaehip. actual legal residence and domieDe in the 8tats et Floeids.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK: r"-"~
THEIR NAMES: ~ 1.
~~unri Feet , )P~Nr~e ~1 ~~e~e~.
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ST.IIlCIE CQ~
aoGER_r__,,,, ..,uot
CLERIC WR6u~~
REtORO YERIFkEO
I F[JRT7iER CERTIFY that I will register at mT local address when the registration books reopen. and eompiT with alt
other requirements of a bgal resident of this State. -
I F'iJRTHER CERTIFY that I have no intention to return tom former domicile. and I iatend to remain in
U C I E ~h,
((Str)
Florida. permanend;.
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Sworn to and subacnbed before me this ~ daT of k
A.D. i ~r
R P01 AS ERK OF G IRGUI T COtd2T
f
ST. LUG 1 E COUNTY, 'f LOR 1 DA
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EPUTY LERK
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