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D~clara~ion of Dor~icil~ and Citiz~nslii
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TO THE CLERK OF THE CIRCUIT COURT. -
ST. LUG 1 E CpUNTY~ FLORIDA:
This b m~ declaration oI Domicile and Citisenahip in the State a~i Florida that I im Slin` this daT is aooordanoe. snd is
conformitT wKh Ssetioo 222.17. P7csida Statutes.
I was i~r a legal resident at ¦w~~- and I f
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resided at However. I hive changed ~ domidle t0
18trMt and Nos>bry .
and am and hive been a bona fide rdddent d tba Stats of Florida sines da,T d
1!;_, and I reside at
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ST. lUG i E Constr. .
and this statement b to be tal~en as mT deelsrstion of dtisenship. aetnal legal residence and domia7e is the State a[ Florida.
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If FOR THE PURPOSE OF EHRO~t.ING If fOR HOMESTEAD PURPOSES
CHftDREIiI IN SCHOOLS PLEASE STATE PLEASE CHECKS
THEIR HAMESS
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I FtJltTliER CERTg'Y thst I wi11 register st nqT local address when the registration books reopen. and comp!, with aII -
otber regairements d a legal raiddat at thb State.
I FURTHER CERTI>•R that I have no intention to rebore tom former domie7e, and I intend to remsin im
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Florida. permaoead,•.
1980 23 IUt !1= 1 ! . - - -
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