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D~cla~a~~on of Domic~lQ ar~t~ ~l~i~~n5iil~
4 press
TO THE CLERK OF THE CIItC[JIT COURT.
ST . LUG 1 E COUNTY. FLORIDA:
This is mp declaration d Domicile and CItiunship in the State of Florida that I am Sling this d:a in aeeordanoe, and in
oonfozmitT with Section ??'1.17, Florida Statutes.
I was formerly a kgat resident d P i i~Sa d Q ~t]c~t3n~~~ ~ p _ N• ~1 ~ and i
1 ) 18taiel
resided at ~ X Loo R • d ~ ~ d~i~~ ~ ~ - Howaver, I have e~nged mT domcDe b
- lsi:~.,aaxome.~l N.3.
and am and have been a bona Sde resident of the State d Florida since t l~~c?,.,~!
-,i_ . ? r dp d
C 19~._, and I reside st ~ y.,,~ j'+ t L~ c~ ~ ~t
_ t$ire~t aad Nambrl
~jrt, ~ i Q - ST. LUG 1 E CountT, Florida.
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and this statement is to be taken as m~ decLration d citizenship. actual kgal rasideaee and domicile in the State of Florida.
IF FOR THE PURPOSE OP ENROLLING IF fOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CNECKS
THEIR NAMESt
r 190 NAR -3 PN 2~ 16
~ ~ ~ ~ USt e FILEO fhl' G~COK:iEQ
ST liklE %uuiiiY.fl A-
U C CLEPK
C RCU1 Ct~i
n
- ~ 4'7"l8~6
I F[JRTHER CERTIFY that I will register at mT local address when the registration books reopen, and oomph wkh aII
other requirements d a legal resident d this State.
I FURTIiER CERTIFY that I have no intention to return to mT former~'c'e. and I intend to remain in
~y JT . LUG 1 E . Conntj.
I i ~ ~J~~ vG ~ (G7t~I . -
Florida. permanenti,•.
.ura~t~ _
_
-r,
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Swann to aad subsesibed before me this ~7 dad d_ ~ 1, l ~ ~ uC ! ~ , ~ ~ ~a-
t Q
ROGER POI TRAS. CLERK OF C IRGUI T COtdF2T
ST. LUG 1 E COUNTY, f LOR 1 ~ .
BY: - -
EPUTY LERK c~ ~
BOOK J~• PAGF~,~