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Dec[arataon of Domicile and C~tizensh~p
ro~cl.~~oFr~cIItcvrroouz~r. 4`409
ST. LUG 1 E (,otlAri'lt. FLORIDA:
1'iis is deelaratioe d Domiale and t~enship in tie State d Florida that I am flies this da,T in acoordanoe. and in
eonlormiV wits Section 2?2.1T. Florida Stawtes. Q
I was forme a kaal r+esidesR d R ~ D - 7~ .Y . S and I .
l tQi41 IStatet
resided s: 9~~ I~rµ a S n J~A/ G ~ -However. I have eiaeegea m~ aomia7e to
t9uwt d Ne~~rl
and am and have bees a boos Sde resident d tie State d Florida since ~U ~ ~ ~ dad d
l9.~Q_. and I reside at 9 ~ Q FrA ivC ~ S ~ 13
18trMt ad K~beH
_ ST . LUG i E ~7• Florida.
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and tiffs statemmR is to be taiea as mT deda:ation d eitiaenship. aetnal legal residence and domies'k is the State d Florida.
IF FOR THE PURPOSE Off ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN iN SCHOOL, PLEASE STATE PLEASE CHECKL
THEIR NA/MES: n
4y'~'409
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- ~0 At~~ 26 Phi 1= O7
• F4fQ RItC FfCOR~tO
ST. LIME COIN! 1Y. Fl A.
CLERK CIRC UT
COLT T
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I FUATlIEit (.ERTIF'Y fiat I wiQ rem at m~ Iced address when tie regidsatioo boob reopen. and oomph with aD ~ -
otter reg~s d a legal rhideat d this Stag
I FURTHIIi (~RTg'Y thst I have m intention to r+etnrn to m~ farmer domiale. and I intend to remain in
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~T^ u~ a ez . CoomtT.
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Florida. permanrnti; -
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IN..d
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S.rora to and sobaarbed before me tiffs ~ daT d
A.n.I Q ~ U n n ~
ROGER POI lRAS, CLERK OF G IRCUi T COtdRT ~ - I
ST UG I E COUNTY, FLOR t OA - -
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EP Y K
- - _ X337 P~1034 ~ -
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