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'rb THE CI.ERK OF THE CIRCUI'T OOURT.
ST. Ll1G I E ~pUNry, ~t,pRIDA; '
This it m~ declsration oi Domicile and Gtitizenship in the State of Florida thst I am filing tbls da~ in saordance. and in
conformit~ ~citb S~ction 222.17. Florida Statutes. - ~
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I a•as lormerlS a legal resident of t-- Q~~ ~ r'S l/~ {~ ~ _~d /~~.~ and I
~/ ~ lCit7) • (St+i~
re s i ded at ,1 [~' I~ ~~ ~~~ ~~~ ~% ~- . HoR ever. I bave cbanged a~y domic7e b
( S:ieC. aad Nmabet)
and am and ha~ e beea a bona Sde resident of tbe Statt of Florida since ~~ n' • da~ ad
~ y - 19~ ~, and I reside at ~ p~ a Tv ~C~u ~ S
v (Stre6lrud Numbes)
C T: Ip J Q~r C.. -e_. , ST. L UG I E Count~, FJorida.
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nnd this statement is to be taken as my declaration oi citisenship. actual legal residence aad domicile in tbe State ot Florida.
" I P FOR THE PURPOSE -OF ENROLL ING
CHILOREN IN SCHOOI~ PLEASE 3TATE
T HE i R H/IMES:
'~ D~N C~~ I~U 1~ L. -..l~~
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i I FLTRTHER CERTII~'Y tbat I~71 register at my local address when the registration books reopen, and oompl~ witb aD
j o:her requirements oi a legal resident of th~s Stste.
~ I F'TJRTZ~ER CER1~'Y that I have no intrntion to return to m~ former domic~e. and I intend to remain in
I -- 5 T* L U C 1 E CountJ.
i ~~~~ _ .
~ F'io:ida, permanenti~.
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S~ orn to aad snbxn'bed before me thia ~ 9 da~ ad ~~ C i I"_.c_en~~-~.. .~i~~ %~~
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~ ROGER P01 TRAS, CLERK OF G I RGUI T~OCfitT
~ ST. LUG 1 E COUN7Y, FLOR 1 OA •
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! B Y : ~~~„ a
~~~~ UEPUTY I.~ERK
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BOOK ~47 PaCE 31
198t J~'~ I 9 A,H ;~ I 5
Fn ~t~ ~hc F: cur~=t n
ST. wr.iF cCUV t Y f t~.
RQGER POIiRAS
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iF fOR HONESTEAD"PURPOSES~
PI.EASE CHECK: ~
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