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TO THE CLERK OF THE CDiCUIT COURT.
ST. LUG 1 E ~pv~y, F-I,pRID~; ' -
This is m~ declaration oi Domicle and Citizenship in tbe Stat,e of Florida that I am filing this da~ in aaordan~e. and ~o
conformit~ a~tb Sectioa 222.17. Florida Statutes. ~ .
I R-as lormerlc a Iegal resident ot ~/~ELr4il/ _~/'~J~/ V a,nd I
I(~'a~) tSe+t~l
resided at ~7 C~/-GQ~iQ,/~c/G~O.O ~iP Ho~ever.I bave cbangrd ~ domic7e to
(S•.reet and Naanber) •
End am and have been a bona fide res;dent of tbe State oi Florida since ~- da~ o[
,/~i~/9/L _ 29 7~ and I re9de at ~~ .~i ~ ~7i~~"EiY~oit/ /~ /G`
(St~eet sad Number)
~..PT ,,,a`'`~T. ,~ir,~~i~' ST. LUG 1 E ~~ti, ~ori~
tc~~ -
and thii statement is to be talcen as my declaration of eitizenship. artual legal resideace and domic~e in tbe State ot Florida.
~ I F FOR THE PURPOSE -OF ENROC~ tNG
CHIIOREN IN SCHOOL~ PCE/lSE STATE
THEtR N/INES:
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~~~~
I F FOR HOHESTEAD~ PURPOSES~ --
PLEASE CHEtK: ~
1~8! J;iN I 6 A!i I!~ 1$
~ILEC tAC Ff''Oi+•.IFP
ST.LUCIf COUN(Y.fIA.
R06ER POlTR.SS
CLERK C~f.CC;: CGU~;/J
F-~r~..~. ~. :~' ~~f----
514U08
I FITRTT~R CERT'g'Y that I wHl register at m~ local address ~vhen the registration books reopen, and oompl~ vvitb aD
o:her requirements oi s legal rtsident oi this State.
I FUR77~:R CERTIFY thst I have no inteation to retorn to m~ former domie~~. and I intend ~ to remain in
; - -y.~' % ,~ ~ - 4 .~ i ,. ` . yT * L U C f E Count~.
16t~) .
~'lo:-i3a, permanenii~. -
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LC~F CCUNiY . F ~~
S a orn to and snbsrn'bcd betore me tbis ~~ da~ od
~ ~~~,. ~.- / 98/
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ROGER P+01 TRAS, CLERK OF' C lRCUI T C0~2T
ST. LUG 1 E COUNTY, fLOR tOA •
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