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Declaration of Domicile and Citizenshi ~
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TO ~ CLERIC OF T~ (~RCUIT OOURT.
ST. lUC 1 E app~~ ~Og~~ ~ .
This is ~ dsclaratioo of Domie~ and Citiaeasbip in tDs. &ate of Floelda that I am ~ this dq is aeeordaaos. aad is
• eoofoemif,T wltb Seetioa >"~.17. Floeida Stat<ttas.
I was t a k=al resident at L" • ~ ~ A~. ~ / / 7 ~ and I
/'74RA~ S ~ rori~ le~+w
resided at ~ 7 /1)ts - Howse. I ba.~. eti.n=.d mT aomieG. to
. _ (8tr~etasiH~
and am and bays been a bona i3de:widentettbe State atFlaida ainoe u t ` ~ / dy of
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iS_. and I reside at E E J r
~o oRT S7.' ,(..uGE ST. LING 1 E~~
, • - Coimt~. Flocjda.
and this !statement is to b• taken as ~ dse]aratioa at eltisenship. aetnal ~ rMideoos and domieifs is tbs 8tats a[ b7orida.
" IF fOR THE PURPOSE 'OF ENROLLING Ii iOR NOMESTEAD PURPOSES
CHILDREN IN SCMOOLa PLEASE STATE PLEASE CMECK:
TNEtR NAMESS
1980 SEP ~ 12 NI il= 45 .
CLERK CIRCUIT t
RECORD YERIFICO -
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I FIJATII~i CF.RTII~'Y that I wID at ~ !Deal address wbea the r3oa books :eopea. and aompl,~ wits aII
I other requu+emeats et a Legal reddest of this 8Lte. .
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I F'[JR'PHER CERTIFY that I have no iateation to return tom foemer domidie. sad ~I intend to remain in
1Cic~) ~T'
- 1:7orida. P~~.• ~ ~ -
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= 90 ~'psT B~,J
- Swoen to and anb.eribed befoe+e ass this dq d
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~ ROGER PO1 TRAS. CLERK OF CIRCUIT COld2T ~ ' ~ "
ST. LUG 1 E COUNTY, 1'LOR 1 OA
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- - BY:
EPUTY LERK ~
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AGO Fc+-m 71 22 ~
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