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Declaration of Domicile and Citiiensh~p
4'78.508
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E COUl~1TY. FLORIDA:
This is aq declaration d Domkile and GYtissnship in tbs Stats d 1:'brida that I am ~ thb dq is aoooedanas. and is
oonformit~ with Section 228.17. l<7aida 8tatntsAs.'
I was i~ a legal resident d I E F F 5 _ D~ ~ D and 1
IQ41 ItRatsl
resided at i.~ 0 ~ ~ - Hawewr. I have ehaoged my domieDe to
(8tiwt mi Nss~Mrl .
. and am and have been a bona Bde resided d th6 State d)E7orida sine - ~ ~ dq d
J andlreddsat i 3 8 S• E • m o h ~ ~ ~ S-~ -
~ lsa..t..aHswel
~'o~~ - L ~c t w_- - _ ST. LUG 1 E CoaatT.I+Ioriaa.
~aa~
and this statement b to bs taken as mT dseLrstion d dtiaenship. adnal legal ~esidena and domidle.In the State d)E7orida.
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IF FOR THE PURPOSE-Of ENROLLING. IF fOR MOMESTEAO PURPOSES,
CHILDREN IN SCNOOt., PLEASE STATE PLEASE CHECK2 ~ -
~ THEIR NANES:
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- REf~ItO YERp'tE0
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~ I FURTHER CEIiTII~'Y that I will register at m7 local address when the registration books reopen. and wkh ail
other regmrements d a legal resids~ d this State.
and I intend to remain is
~ I FtJBTHEB CERTIFY that I have no intention to ratnrn to former .
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~ . Coomtj.
Florida. rmanensi; .
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Sworn to and ms this ~ daF d ~ - l
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a.e.c,~ , A.D. I~
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R ~'~O i TRAS. CLERK OF C I RCU I T COt~ItT
ST. LUG 1 E COUNTY, fLOR 10A - ~ ~
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- BY s
~~EPUTY LERK
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8
- AGE Form 71-2F