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514189
'1Y~ THE CLERK OF THE CIRCUIT COURT.
_ ST. LUG 1 E COVNTY. FtARIDA: ~
This is m,~ declsration oi Domic~e and Citueaslup in the State of F7orida that I am 51ing thIs ds~ in accordance, and ia
co~formit~ v~itb Scction 222.1?. Florids Statutes. ~ .
I~~as lormerly a tegal resident of lr~NnC ~iR~- , and I
. l(~71 lSt.,W
re s ided at . HoR ecer. I 6ave et~snged m~ domic~e t,o
(S•.reet and N~ber) •
a:: d am snd ha~ e beea a bona fide resident oi tbe State of Florida sina dq o[
_ ,19 and I reside at ~/~ l I~LE"AND E]C' /4 ~~li~U E-
(Street aad Numbes)
ronr Pi~ec~ sT. ~uc~E
`~i' , CountT. Florida.
and this statement is to be taken as my deelaration of citizensbip, actual )egat residence and doatic~e in tbe State oi F7orida.
" J F FOR 7HE PURPOSE -OF ENROLL ING
CHIL~REN IN SCHOOL~ PLEASE STATE
7HEIR NIIMES;
I F FOR HOHESTEAD~ PURPOSES~ ~-
PLEASE CHECKt ~
•
t9Bi ,!~!~ t 9 PK 7: t 3
FIL~p IMf F'_'CGk:~F(?
ST. (.UCtE COUN ~ Y. ft A.
ROGER P017RAS
CGERK cr~c;;~; i,!'Ln? ~
AE~.^.Af. ~'~ E~-... ~
~1~1Q~
I FURTI~R CERTII~'Y that I~11 register at my local address v~hen the registration books reopen, and compl~ v~itb aD
c:her requir~meab of a legal resident of this State.
I FLTRTHER CERTII~'Y that I have ao int~ation to return to m~ former domic~7e. and I intend to remnin ~n
~ : JT* LUC1E ,~~tT•
((St~) . .
F']~:ida, permanent5~.
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ROGE P01 TRAS CLERK OF C IRCUI T COCdi2T
ST . LUG I E COUNTY, f LOR i OA •
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BY:
~ EPUTY I.LERK
~ " BOOK 34 7 ~A~E 140
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