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Declaration of Dom~c~~e and Citizenship
4'79'18
TO THE CLERK OF THE CIRCUIT COURT.
ST . L UG I E COU~Y, FLORIDA:
This is my declaration of Domica7e and Citiaenship in the State of Florida that I am fling this day in secordanoe, and in
conformity with Section 222.17. Florida Statutes.
I was formerly a legal resident of ~e GZ ~ ~ e w ` ~ and I
Ju a 1~,, Is
resided at _l ~ ~ ~ h . However. I have changed my domiede to
IStae•t and NmmUar)
and am and have been a bona 5de resident of the State ai Florida ainoe ~ ~ ~ ~ day oI
' 19
~
b and I reside d ~ 7~~ / n /1~Q
,~O t ~S f~
G-T ~ ! ~ ST. lUG I E ~N~~
County. Florids.
Ic~l
and this statement is to be taken as my declaration of eitiunsbip. actual kgal residence a~ domieik in the State a[ Florida.
J IF fOR THE PURPOSE Oi' ENROLL.ING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NANES:
il/t;l~k~ Slav,' c,~~1~
f980 kllR 17 t'K t~ 22
F0.E~0AN FF: L0
- _ SThOGER PO1T A. i
6lERK ClRCENT CaIR/j~
IlEt.01tR ~~ER!FIED____ ~~~Q-~---- s
7
4'~"9~?'i~8
E
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and eomp~ ~vitb all
other requirements of a legal resident of tbi, State.
I FURTHER CERTIFY that I have no intention to return to my former domie~e. and I intend to remain in
U G 1 E qty,
1(St~T
Florida. permanenti;
t
' ~ - . ti ~i i
f IAdd:•aa)~ i
Sworn to and subscribed before me this ~ dsy of ~d ~ / G ~ G--
A.D.1~~.
ROGER AS CLERK OF CIRGUI T CO~dRT
ST. L UC 1 E COUNTY, 4'21 OA -
JJ'' .
BY:
EPUTY LERK
4ffi i'.,.r.'fj.~