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Declaration of_ Domicile and Citizenship
4'74334 ~ .
TO THE CLERK OF THE CIItCUIT COURT. -
ST. LUG I E oOUNTY. FLORIDA: .
This b aa~ declaration of Domicils and (~asnsbip is the State ad Florida that I sm ~ t>,is dy is aooo~danoe. nad in
eoutar~ with Section 2ffi.17. Flosida Statut~ss.
. I was Ir a legal resident at and I
t
remded at However. I hour changed np damM7e to
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and amand leave been a bona Bde resident of the State oI>:'lorida sines ~ _ - ~ ~
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- and i reside at 5
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and this stateme~ is to taken as q. declaration of eitise. actual legal residenos and domidle in tbs State d Florida.
IF F'OR THE PURPOSE OP ENROt.LIN6 - IF FOR HOMESTEAD PURPOSES,
CH I t.OREN ! H SCHOOL, PLEASE STATE PLEAS-E CHECK:
TH[1R NANES: = -
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- FflEO AND RE60ROE0
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- iAERK CtRCU1T ~ .
J ,ttECC•It9 VERtPtEa
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I FiJR'PHER CERTII~'Y that I wiD register at local adde+ess when the reg6drstion booms reopen. and ' with aII .
other regniremeats d s legal resided at t>tis State.^ - -
. I FURTHER CERTIFY that. I have no intention to ratutn to former domiab. sad I intend to remaia_in
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Florida. permanent; • ~
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~~E cL'iflliY .
SwaeA to aad su before me this 3 0 - ~ ~ ~c{~
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- ROGER POI TRAS,~ CLERIC OF C IRGUI T COCdjtT
ST.-IUGiE-COUNTY, fLOR1OA - - - •
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EPUTY t.ERK
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