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'r0 THE CT.ERK OF THE CIRCUIT OOURT.
ST. LUG 1 E ~pv~rry. F[,pRmw; '
ThIs is m~ deeLration oi Domic~e and Citiunslup in tbe State of Florida that I am Sling this da~ in sccordanee. and ia
conformit~ ~ritb &ction 222.17. Florida Statutes. ~ -
I R•as formerl~ a legal resideat d_~~= s7 ,~/~,~~1~ ~G G~ ,_~I~S'S • and I
- l(~7) ISe+t~.I
re s i ded at /~ CL~~`~T ~/~ .f' ~ T Hoa ever. I bave cbanged uq domic~7e to
(Street and N~be~ -
a n d am and ba~ e beeo a bona fide resident of t6e State oi Florida sinee ~~ -~„r1~?y- ~1~'.ZG~ da7 ~
__ /~UG U.t'T ,19~ and I reside at ~~.3 ~AY.f~/~ GJ2~~" /~/!l s T. ~~
(Stieet ud Numberl
1FGr i ~~~/'~ ~~s - _ ST. LUG 1 E Count~, Florida.
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and this statemeot is to be taken as my declaration of titizenship. actual Iegal residence and domia'le in tbe State oi Florida. ~
" IF iOR THE PURPOSE-O~ ENROLLING
tHIL~REN IN SCHOOL~ PlEASE STA7E
THEtR N/IMESt
IF FOR HONESTEAD-PURPOSESi ~
PLEASE CHECKt ~ ~
~i JQ~~ 20 AN il~ O7
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' I FURTHER CERTff'Y that I w~l register at my local address when the registration books reopen, and eompl~ witb aD
~ other rrquiremenU ad a legal resident oi this State. .
~ I FURT'AF.R CERTII~'Y that I have ao intention to return to m~ former domieile. and I intend to remain ia
~ ,T * L U G 1 E , Count~.
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~ F'lorida, permanenti~. .
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; ROG I TRAS, CLERK OF G IRCUI T COt~2T
ST. LUG 1 E GOUN77, FLOR 1 OA •
BY: -
E PUTY I.LERK
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