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Deciara#ion of Domicile and Citizenship
4'~~6543
To THE ca.ERI~ of TBE CIRCUIT COURT,
ST. LUG i E OOUI~TY, !'tARIDAt '
This is mT deeLuatioa at Doiaiede and Cltiseaehi~p is the State d FloriWa that I sm ~ Chia dy b aoeoe+dasa, and is
ooolormt~ with $+etioo HiR.17, l~orida 8tatate~.
I was i ~?1eEa1 rssideatd 0 t,~
~ h ~ ~ • T ~1 ~t Mo ••a T' .
. aadI
.resided at ! 6 /'7 /r t~~/~'~?~ 5 T~~ l " Haww~ae. iha~ ehaarad a~ doaiieil~to - -
T .ttl~r..t.eil~l..r.el .
snd am and have bees a boos Sde raideot d the State d Florida slag oZ - I ~ ' ~ O dy et
_____l~ K ~ 19~.Glaad I reside at Y ~ ~E L SC~~- 1~.1A '1~ o ~ ~'t~ -
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Itlte..t.e~il~l
~ ~ ~r ~ ST. LUG 1 E 1+lorida,
caul
sad Ibis statement ie to be takes se aq deelaratioa d dt~eoship. adaal 1sEa1 resideaoe and domidM b the State d Florida.
If POR THE rURPOSE OP ENROL~INa IP IOR NONESTEAO rURP03Efe
CNIIOREN IN stHO01.s PEASE STATE rLEASE-CHECKS
THE IR.NAMESS
E' ~ ~ 1
1980 fE6 ZO ~!i ~ 3T -
- = t't1.E0 ANC Bf C
= LUC COUN
t'Ol RA~
tiLtlH< CMtC1NT
VEa1Fi~E0
'~5
- 4'x'6543 r
I FURTHER CERTIFY that I wID at mp? loal address wbea the :egistratioa books reepea. sad eoa~pb with as
other r+egai:+emeats d a legal seaideat d this State. -
I FURTHER CERTIFY that I have no iateatioa to ratnra to former sad I batead to :+eaoait is
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141
Florida. pern0anentl,;.
ti ~
:'d`~~ t ~ , ,L Jib 1/i 4' G'i f%?~
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~~~=''T" 4° '±y~ , ~ % L ~ L ~ / 1~ X1,1-~~
swore to aiid stbaalbed before me this dq d v Z T i 1 ~ a 71`
R A C K C C I Ot~tT
ST. 1 E COUNTY, 1:L~R 1OA~
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8Y: _
E~UTY LERK -
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