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Declaration of Domlc!!e and Citizenship
482438
Td TI~iE cI.ERI~ oFTxE clRCVlTCOURT,
ST. LUG I E Cpv~y~ FLORIDA:
This is o0' declaration of Domicfie and Cltisenship in the Stats d Florida that I am filing this dq in accordance. aed is
conformity with Section 2?1.19. Florida Statutes.
I was former a legal resident d Atha S Dh ~ O and I
(Qk~) (BtaN)
resided at Aowever. I have changed mJ' domia`le to
tStrMt and Nombr) ~
and am and have been a bona fide resident apt the State o[ Fbrida since ~y d
Rttq - _ 19._.,,t_, and beside at /o b /~7Q.p/e
_ F~. P' ercE ~ ST. LUG t Eearc.aaNoe~l
County. >!7ocida,
caul
and this statement is to be taken as my decLration d eitisenship. actual l~al residence and domicDe in the State d):7oeida.
IF FOR THE PURPOSE Oi ENROLLING IF FOR HOMESTEAD PURPOSES,
CH 1 t.DREN 1 N SCHOOL, PLEASE STATE PLEASE CNECKt
~ THEIR NAMES: ~ ~_j
SAer~~e sc4r~bler
19E0 APR -9 PN 2 r 5
- FILEO a~ RFCO~ D
ST. UCIE C TY.fLA.
f~LEl11l CROtCtla1T Co
RT
R8NI1! VfRtf1~0__~~_
482438
I FURTHER CERTIFY that I w~71 register at my local address when the registration booms reopen. and comply with aII
other requirements d a legal resident as this State.
I FURTHER CERTIFY that I have no intention to return tom former domiale. and I intend to amain in
i~L~, C E County.
(Cal~?
Florida. permanead;.
.
.
-._...v~,,t;`~ 1a~ /hip/e ,1.~?e
~ u?aa~..l
-Sworn to and snbsen'bed before me this dry of Ff . P'C rc c ~ L.
. J
A.D.18.
A C ERK OF C IRCUt T COrdRT
ST. IE COUNTY, fLOR10A
• ,
gY:
. PUTY tERK
6000 ~ P~tif Gay1 +