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Declaration of Domicile and Citizenshi
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4833
TO TH>; CLERK OF THE CIIiCiJIT OOURT.
ST. LUG 1 E oovrlTY. FLORIDA:
This is m,7 declaration of Domic~e and Citizenship in the State of Florida flat I am 51ing thin daF in aooordanoe. and in ~
oonformit~ with Section 222.17. Florida Statutes.
I wu formed a legal resident of PY n AG 1
p~ , ~ /l: C' . and I '
1CIt~l Isw.~
resided at ~lL h/?x / ~nnAr! lp ,,~/1. L° ~ 70 43 _ However. I have changed m7 domicile to t
(8a.rt aad Mamba)
r~
and am and love been a bona Ede resident of the State of Florida since ~ ~ dal ~
/~P A /Yl iQ .19 '79 . and I reside at a ~ a ~~T~o~ I~Q
(8tewt aad Nambal
PnQf Sf ,Cucs~ ST. LUGIE ~„n~,~.;~
(CYti1
and this statement is to be taken u mT declaration of eitisenship. actual legal residence and damieRe in the State of Florida.
IF FOR THE PURPOSE Of ENROLLING IF fOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMESS '
Am An~l?~ Rn %
s L-~-o n .
t9~ A~Ju 20 AN i I= OS
~t fIIEU RENC'~~COn0E0 ~
S RO~CsER
PO
RASA i
CLERK CIRCUIT COURjI/
' FECOA(f i'ERIFIft1._.~ _
486833
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Ij I FURTHER CERTII~R that I wr71 register at m~ local address when the registration books reopen. and oomph with all
other r+egnirements at a legal resident of this State. ~ °
i
I FURTHER CERTII'R that I have no ~inteation to retnrn to m~ former domica7e. and I intend to remain in
S T . LUG _ Count,
(Cd))
Florida. permanenu; .
7// l /M ~n
'i
f r` • ~ . ~ M.wl
L'.. ,
j 6wots{o-aod sv>~ibla before me this 2 U daT of r
R GER PO S CLERK OF CIRCUIT COt~2T
ST. L COUNTY, fLOR 10A
' . •
BY: ~
EPUTY LERK
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. ~ - g~,~x337 ~~E 127
AGn Forn 71 ?2 3