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Declaration of Domicile and Citizenship
481302
TO THE CLERK OF THE CIRCUIT COURT. ~
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ST. L UG I E COUNTY. FLORIDA:
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This b ap deeLratioa of DemleDe and Citizenship in the State of Florida that I am filing this daT in aoootdanae. and in
oonformit~ witb Saction 2?2.17. Florida Statutes. i
I was former a legal resident of L.D y /L-L~ w, O~~i and I i
ICkI) (state)
resided at •~j /~/~'c' ~ L ~~~y~ -However. I bave changed m~ domie~7s to
(8treat and NsoDarl
and am and have been a bona Ede resident of the State eI Florida. sines ~ ~ ~ ~ ~ -
_ lg
7? , and I reside at /1 , ~Y~ ? y O y ~
(street aaaNmb~r)
~~,y~ s i ,y ~ ~tij ~'N _ ST. LUG i E ~ County. Flo:;da,
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aad this statement is to be taken u m~ deeLration of dti:enship. aetnal kB+tl residence and domieije in the Slats at-Florida.
!'If FOR THE PURPOSE Of ENROLLIM6 IF FOR NONESTEAO PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK: ~t/~
TNEIR NAMES: 11
t980 MAR 3 i AM tl~ 14
at.ERK C1RClN
- RECOM YER:f tf 0
481302
I FURTHER CERTIFR thst I wt71 register at m~ local address when the registration books reopen. and oompl,T with aII
other requirements of a legal resident d this State.
I~ I FLJRTHEIi CERTIFY that I have ao intention to return tom former domidle. and I intend to remain in
U t 1 E . CauntT.
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Florida, pertnanead; .
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• ,y -
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' iNaasa
(Addeeaal
Sworn to and bsen"bsd before me thb daT of
A.D.1$,~~.. ALAN f~~1, ~
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ROGER PO1 TRAS, CLERK OF C IRCUI T CO~ItT
ST. LUG 1 E COUNTY, f tOR t.OA
BY: - ~
i:PUTY LERK _
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