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Declaration of Domicile and Citizenship
481'734
TO TAE CLERK OF THE CCIIiCUIT COURT.
ST. LUG 1 E OOUNTY. FLORIDA: .
This is aoT declaration d Domie3ls and Citi:e,uhip in the State d Flaeida that I am S1inK this daT is aoeoadanos. and is
oontoemitT with Section 222.17. i!7orida Statutes.
I was forme a legal resident d S~ ~ Q 1 r' _ ~ i U h I ~t n aoa i {
L ICk~1 IlMatd
resided at l q ~ 5 ~ t' e-d ~ 0 o r e. ~ y - - However. I have changed aqT domirRe to
18trMt asa Nanbsr)
. and am and have been a bona 5de resident d the State dFlorida since - a~ ~ h daT d
1~10~ G h .1S ~ ~ - area I reside at 3 ~ al C.h e r t1.11 ~t7Qd
(8trMt..a N..e.ri
'1"". U G 1-~ _ S T . L UG I E Co~mt7. Florian.
lOlyl
and this statement is to be taken as aqT declaration d eitissnship. adnal legal r+esidenee and domicile in the State d F7arida.
IF FOR THE PURPOSE Oi ENROLLING IF iOR HOMESTEAD PURPOSESa
CHILDREN IN SCHOOLa PLEASE STATE PLEASE CHECK:
~ THEIR NAME8S
~7en1, _he~l ~{e I~u=ar~ ~q~p APR -2 PK ~ 48
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~ r ~~c. A~ Yh o r ~ e, n w a r d1 0 ~I+c ~I:colloto
= ~~~e~~Ra~~"
`~rgnca~ l-e ~ Ken wad cca~clm
~11iERIFIEO~
- - 481'734
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f I i•'UATAF.R CERTIFY that I will register st m~ foal address when the registration booiu reopen. and oompiT with ell
dher regainmeats d a legal resident d this State. -
I FtJATAER CERTIFY that I have no intention to r~eter_n t_o mT icrmer domie7e. and I intend to remain in
~ J/ . L V Y~ E ~
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_ 1~) - ,
Florida. permaneml; . -
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V .V..C ~ 1, ~ l
3~tG GHe.er.' i-~~~i~ ltd
Sworn to a~ sabeeribed before me this dad d ~ ~ ~ UL ~ ~
A.D.1$~~
3
ROGER P0ITRAS. CLERK OF G1RCU1f ~Ot~2T
ST. L UG i E COUNTY, Ft.OR t OA -
_ . - . _
BY:
• EPUTY t.ERK -
BuoK cX~ P~f~