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Declaration of Domicile and Citizenship
49'~'3~1
TO Tlilr CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E COtTNTY. FLORIDA:
This is nq decLratioa of Domidle and Citisenship jn the State od Florida that I am fiiiag this dsT in acoordaaoe. and is
oontormity with Saetion 222.17. Fbrida Statutes.
I was former a kgtl resident of L OV i fy G~Z
o ~ NE c,..) MEX / G o ~ I •
tt~tpl. IStatN
at _ 90G W . .S~fFf-+Q_co~J Aowever.I have changed my doavea7e to
(8t~t sad NambKl
and am sad have been s bona fide resident at the State of Fbrida since ?rte ~ ~ day et
AwausT ,19 ~o •arealresideat ~e ~`o~ IVot-rh AyE
Four- P~eRcE.._ ST. LUG I Est~..~.aaN~l
County. Florida.
and tJ~is statement is b be taken sa m7 declaration at dtiumhip. adnal legal residence sad domiale in the State at Florida.
IF FOR THE PiJRPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES, ~
' CHILDREN IN SCNOOt, PLEASE STATE PLEASE CHECK: r j-~
THEIR NAMES: ~ ? 1 ~
49'7~~-
EL~ZA~CTI~ ~ • ~A: CE y
.t
. t980 AIfG 26 N{ 1{~ 3B
' S R~ER 01 RASA•
CLERK CIRtx11T COURT
RECORD I'FRIFlfO.r___.___ -
I h'[JB1'IIER CEI;TIF'7f -that I wdl rQgister at my local address when the registration boob reopen. and comply with all
- - - - ~ -
ather regniremeats d a legal reaide~ of this State.
I F(JRTf1F.R "CERTIFY that I have ao inteafioa to return to my former domia7e. sad I intend to remain is
_ UCIE
- tt7ajl _ .County.
Florid:, permanenu;.
"
s,. _ _ , - Cam:
~?'4+x~~'°F tA88ewl
Sworn to and snbsaribcd before me this day of _
C~~~ ~
A.D.1 O . ~v ~N J. 3A; /e~
ROGER POI TRAS. CLERK OF CIRCUIT COr~FtT
ST. LUG 1 E COUNTY, f LOR 1 DA ~ .
BY: C~~.. ~u-~~cc
EPUTY L~RK