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Declaration of Domicile and Citizenshi ~
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482'78'7
TO THE CLERK OF THE CIItCU1T OOURT. }
ST. LUG 1 E o0vrtrY. FLORIDA: `
This is n41 declaration of Doaaicile aad Cltiasnship is the State ai Florida that I am ~ this daT is aoooe+dance, and in
ooniormitT with Section 228.17. l:7orida Statutes.
I was for r a legal resident of ~ ~ ~j t ~ ~~S"y 3 s' a~ ~
IW) 18t~Rel
resided at l~C G -(ti f ~I i , ~ .
18tirst yd Naob~rl However. I have changed domicils to
and am and have been a bona 5de ree3dsnt of the State of Florida ainoe ~I ~ ~ ~ l % c~1' ~ ~
19__. and I reside at l1 ~ ~ ~Q ~ ~ %'i 'liU S ~vli, ~ . ~/Jt i r
(BteMt and Nom~r)
~v R T ~l ~ k < F~ ST. LUG i E Count.
Icatil
cad this statement is to bs taken as m7 dee4ration of citizenship. actual legal reaidenoe and domia7e in the State of Florida.
" IF fOR THE PURPOSE OP ENROLLING IF i!OR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
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482'78'7 ~
1
I FURTHER CERTIFY that I wdl register at mT loci] address when the registration booms reopen. and oomph with all `
other regwrements ~ a legal resident of this State.
I FIJRTBER CERTII~R that I have no intention to return tom former domic~7e. and I intend to remain in
_ U C I E ~ L`ppnt~~ s
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Florida, permanend; . s
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..s ~ ci
- Swb~dto yi ' ` - before me this - `-~-day of _ L ~ 1 ` ~ ~ t
A.D.1~ ~
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R R I AS C ERK OF CIRCUIT COrdFtT ~ i
ST. LUG E COUNTY, FLORtOA
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EPUTY LERK
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