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514165
TO THE CLERK OF 7'HE CIRCUIT COURT. ,
ST. LUG 1 E ~p~~y, ~,pRIDA; ' •
This is m~ dedaration of DomicDe and CHizenship in the SLate oi Florida that I am filiog th~ da~ in acoordaoa, and io
conformit~ ~itb Section 222.1?. Florida Statutes. ~ -
I a as formerl~ a legal resident oi Pa•.? uc ~h ' , K V a,od i
. ICa71 lSt+t~1
msided at ~ . HoRever.I bav4 cbanged my dom~c~e to ,
(Street and Nambe~ ~
and nm and have been a bona fide resident oitbe State of Florida sinee ~~! -T~, 1 A^ 7 da~ a~
_T~n -19 n.~.i -andIresideat .r~~ ~-- ^t~?
(Stseet aad Number)
~t Y~.crce ST. LUG I E
. CountJ, Florida,
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and this statement is to be taken as my deelaratioa of citizenship, actual legal residence and domic~e in the State oi Florida.
" IF FOR THE PURPOSE~OF ENROLLING
CHILOREN IN SCHOOI~ PLEASE STATE
ThEiR NAMES:
- - Richard 1lntoney Sprincjer
~
IF FOR HOMESTEAD-PURPOSES~~-
PLEASE CHECK: ~
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I FURTHER CERT'IF'Y that I~71 register at my local address when the registration books reopen, and oompl~ witb aD
o:her requirements oi a 1ega1 resident of this Stite.
I FLTRT~iER CEATII~'Y that I have ao intention to retarn to m~ former domic~e. and I intead to remnin ia
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S F orn to and subsrn'bed befori me this ~ 9~ da~ o[
~~...~ ~.. / 98/
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ROGER POI TRAS* CLERK OF' G IRCUt T COCdi2T
ST. LUG 1 E COUN?7, FLOR 1 OA •
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