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claration of Domicile and Citizenship
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482926
TO THE CLERK OF THE CIRCUIT OOURT. '
ST. LUG 1 E COUNTY. FLORIDA:
. This is mT declaration of Domicils sad CSiseaship iA tbs. Stats at Florida flat I am ldin6 this dy ~ acsoedaaa. and in
ooniormit~ with Section 222.1?. Fbrida 8tatutes• / .
ICf ~ ~"S i P~ _ ~e ~ f ZI i /a i i1/11~_ aDd I
I was i~ a legal resident of ~ -1~. iii tg~,e{/
resided at _ ~ t~ ?
c~ ?.~a However. I have ehaagea aU do~ni~ to
and am end have been a bona f de:esicls~ of the State at Florida arose
- lA - and I reside at Z ~ ~ ~
18~rMt, aid N~bw1
~ ~e Y C ~ _ ST. LUG I E Cannty. Florida.
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and this statement is to be taken as ~ declaration of dtisensbip. actual legal residence and domiAe in the State d Florida. }
IF FOR THE PURPOSE OF ENROL.{.{NG IF FOR HOMESTEAD PURPOSES,
CH{IOREN {N SCHOOL, PLEASE STATE PLEASE CHEGKII
THEIR NAMES:
. . /yl e 1, ~ s.g ~A.nES _
X80 APR 1 ~ AK 11= S t
r-S~e clD ~ ~ A~ ES a~°uc a~~ii °~p~.
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• G/1 ~ ~f
~ ~ - OLERK CIRCtItT
~ta}tj YE'RIFIEO
i
I F'tIRTHER CERTIFY that I w~71 register at m~ local address when the registration books ~+eopen. and .oomph with aD
,other requirements of a legal resident at this State.
I ~R CHRTh'Y that I love no intention to return tom farmer domicile. sad I intend to nit;.
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FlOTidi. perlpaDentlj. ~ '
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SwcArq to and saadp~
ROG R PQITRAS. CLERK OF G1RGUIT COraRT
ST. LUG1E COUNTY, FLORIDA ~
EPUTY LERK
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