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Declaration of Dom~~ite and Clti~enship
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To~c~oF~c~curroovar. _
ST. LUG! E- OOUNT'Y. FiARDA: ' - ~ •
1tis is ~ dsdsration d DeoieRe and t#iaaas6ip u tM State d 1ilorida tAat I aae 5ffig t>tis ~ is aooordasoe. aced i1
aoatoraeiq with Sedio~ 1;!2.17. Floelda Statates. -
- I was foemer aleaal resideaR d - ~ • ~ and I -
resided at - ~ _ >Io~we~er. I Dare e>tageed nq aoeaio'1s to
IstnrtarNn~Mr;`
and ass and >ta~e bees a Doea Ede re~ideaR dtis State d Ffoeida sinuee ~ 7 ' ~ d~11 d
• Is~ and I ere:aaa a ~-r •3 ~ l l /l~~ - - -
.N - wr~.~..~ l8teaat ae~d N~~rl 1
ST. LUG ! E g~~ ~
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and this atateaeaR is to be tal~en as aq eeeLratioo d • aetnal lean! reaideaee and aomiole in tle State d Florida.
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if fOR THE PURPOSE Of ENROLLING !i: FOR NONESTEAD PURPOSES, -
CIIILOREM ~tN SCHOOL, PLEASE STATE, - rLEASE CHECK: - -
THE NAMES: -
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_ _ _ 198ii -
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1~EMFiEO--
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I PZJATHI3B (SBTIFY tltst I wi resister at aaT total adelress wleen the rioa boobs reopen. and oomph wits all
fiber regearesrab d a kaal ieadeat d tleis State. -
I FUlrl'HEB (~Et'1'IFY that I no iadeation to actors to >~fermer domio'ie, sad I iafead - to rasaia im
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sworn toand s~baribed beio~e ae tiffs 3 d - daj d - -
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ROGER POITRAS. CLERK OF' GlRCU! T COR~tT -
ST. LUG 1 E COMITY, Ftdt tQA - - - `
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PYTY -LERK -
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