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I ration of Domicile and Citi~ensiii ~
Dec a ~
4'~84'~O '
TO THE CLERK OF THE CIRCUIT COURT.
ST. lUG 1 E OOUNTY. FLORIDA:
This is aql? declaration d DomicDe and Citisenship in the State d >'7o~rida that I am ~ thL da~? is aooordanoe. and is
conformitT with Section 282.17. Florida Statutes.
I was [o~r a legal rasideat d ~~a ° k ~ Vs w Yo~P ~ aadI
1x41 (8tatd
rasided at ~ o /~9>f`i?o v •t-.o - However. I haw changed u4 domicils to
IStraat aaa Iias~DaN •
end am and have been a bona Bde resident d the State d Flo~da since /P ° ? ~ - /~1 d~ d
~V o d - .1! and I reside at /~F •ta / ~?~rA• r~ •~/f JT
(Strad aadNusbae)
r ~,1' ~ .l e I ~ ST, LIIG I E ~ - _ Connb. Florida.
(c~41 - -
and this statement is to be ta)<en as ~ deeLratioa d eitisenship. actual legal residence a~ domieDe in the State d 1:7ocida.
If FOR THE PURPOSE Of ENROLLING If fOR HOMESTE/10 PURPOSES,-
CHILOREN IN SCNOOL, PLEASE STATE PLEASE CHECK:
TNE1R NAMES:
~0 lIAR -6 ~M ilt 4~
i8At11lt ODIMtT
- R'€NRii VEIt1F1EA
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I FiJRTHER CERTII!'Y the I wtU regid~er at ap loesl address when the registration booiu rso~pea. and eompjf with aD
other regniremeats d a legal nsidsnt d this State.
I FURTHER CERTIFY that I have no intention to return to mT [oTmer _domiese, and I intend to remain is
JT. l~UC1E - -
(Gttj?1 = -
Florida. Permane~i- e
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tit;A,~f~ulk~j~~~
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:.t . • (Nagel
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~ ~ `J sobeeribed be[a~e me Ibis ~ dq_d- - -
~ A.D.1 ~ J~nrdr eu' ~ ' ~u wi~ hR e~~
R A C K OF G tRGU OC~tT
OGER P01 TR S. LER t T C
ST. LUG1E COUNTY, FLOR1
• BYs r ~
_ EPUTY LERK