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Declaraiion c~~ Da~icil~ ~~d Ci~iz~nst~ip y-
. ~1340'7
TO THE CLERK OF THE C~iCUIT OOURT.
ST. LUG I E ~p~~y, ~,p~pA;
This Lt m~ declaration ot Domica~e and Citiuenslup in the State of tlorida t~ut I un filing this da~ in seoordance. and i~
conformit~ Rit6 Sectioa 222.1T. florida Statutss. ~
I R~s formeri~ a Iega1 resident of ~' /~/~/1 z U~- . /-/ j~~ aad I
~ ~ 1 ~ Ai2 F~Q 2 ~ ~ ~~ _ ~~~ ~~
resided at f - _ Ao~e~er.I bave c~nged m~ domiek to
(Strcet.ud I`ombet~ -
and am and have beea a bona Sde resident oi the State of Florida since .~ 7~ h d d
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/~C7 !/ 19 ~G _ and I reside at _G ~ ~ ~r~`l~ rN ~ ~'3.3~/
ts:~: ~e ~~~
,~ y~v ~ e G c ~~ ~ ~v ,r~ fZ ~/ ~ir~~ ~-~ ST. LUG 1 E c~c~. ~;aa.
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and this statement is to be taken as m~ declaration of citizenship. adual legal zesidence and domiale m tbt State oi Florida.
" IF FOR THE PURPOSE OF ENROLLING IF POR HOMESTEAD-PURPOSES~ -
C1ifLDREN iN SCHOOL~ PLEASE STATE PLEASE CHECK: ~
THEIR NAMESL
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RGGER PCITRAS
C.Efi~!( t~,C'~'.T it~~;-
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I FURTHER CERT~'Y tbat I w~71 register at m~ locil address ~hen the registntion boolics reopen. and compI~ sritb aD
other requirements of a legal resident oi this State.
I F[JRTHER CERTIFY that I have no intention to return to m~ lormer domin7e, and I intend to remain in
T. UCIE .~t~.
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F'lorida. permnnenti~.
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Sworn to and s~bscn'bed befort me tbis ~ 3~ dq d ^
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ROGER POi 7RAS. CLERK OF G IRCUI T CO~di2T
ST. LtJC i E, COUNTY, F'LOR 1 OA -
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BY: ~I~-~-~
_ EPUTY LERK
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