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Dectaratton of Domtctle and C~tizensh~p
48269
TO THE CLERK OF THE CIRCUIT OOURT.
ST. LUG I E ap~y, gI,O~A;
This b aqy dee]aration of Domicile and Citisenship in tbs State at Florida that I am illi~ thb dq in aoootdaaos. and in
conformity with Section 222.17. >F9orida Statutes. ~ -
I was f ~ a bKal t+ssident of ~ ~ and I ~
resided at i GL~C- Ql ICk71 t
- However. I have changed my domidle to
Iti~tsaaNss~ y~ ~
and am and have been a bona Sde rsaide~ atthe State otFloeida ainoe dKy '
' `G~~~' l~
~ and I reside at -
18trwt sad Nash
~Lt ~t.c;o) _ ST. LUG 1 E
County, Florida. ~
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and this statement b to be taken as my dee]aration o[ dtisenship. actual bgai residence and domidle in the State ai Florida.
_ Ii FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
t:N1LOREN 1N SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
.
X80 APR ~ ~ All 1~ ~ 2
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I FURTiiER CERTIFY that
I w~l ngutter at my local .address when the registration books reopen. and oomph with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return tom former domicile. and I intend to amain in ~
U 1 E . minty.
Ipt7) -
_ Fbrids, permanend; .
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. Sworn to and subscribed before me this day of -
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A.D.l$,
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R f A C K OF CIRCUIT COC~2T
ST. L IE COUNTY, FLOR1
~ R 1
- - BY s
. EPUTY t.ERK '
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BOOK P~ I
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