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Declaration of Domicils and Citizenshi ~ ~ . ~
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Tom coFzxscn~ccurroa?vlhc,
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~ ~ ~ dee4rstioll et Domieik and C~tbeaabip is tb. slat. d Florida that I am ![tom tMs dq is aoooldasos. Ind is
writs S~elioa 2$8.17, Florida 8latntee. .
I wu i a kcal reddeaR of Q•,L-~••• ~ . . sad I
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:raided a t~.0 ~ p~_., • ~ ~ - $vw.~,?er. I lie eb.ased ap dosieD. is
and ant and have beso a boos side reddest got for State et Flodds dos ~ l 7 ' .Y D dq d
18__.__. sad I reside at •1 ~~..a~~`s„ ~{a . . '
_ ST. LUG 1 Et~••R m+N..b.e1 Florida.
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aqd Ibis statement is to be taken as ap dselarat3os at dtisfnabip?, actual kas~l reddsnes sad domidle is the $lste d Florida.
IF FOR THE PURP08E OF ENRO!llNa IF fOR,=NOME8TEA0 PURP08Ea,
CNIlOREN IN 8CN00l, PlEABE BTATE PlEABE~CHECK!
THEIR NAMEBi
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19~ FE8 18 AM 11~ 41
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I FUAI7I~R CERTIFY that I wiD register at aqT ioal address wbea the seKistrdioa books ieopsn. sad enmpy with aII
other regairameats d a kpl reddenrt of Ibis State.
I FURTIffdt t2rltTiF'Y that I brn oo intention to return to n~ former domidie. sad I intend to :elnaia io
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I'70l'ida. permanes~;
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FC~lrNTY. ~0~~0 ~
Sworn to and albeerbed befae+e.me this ~ dy d
A.D.1~,~;
ROGER POI TRA$. CLERK OF' G IRGUt T C~tT
ST. LUG i E COUNTY, fLOR tOA
8Y:
EPUTY JERK
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