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515191 ~
TO THE CI.ERK OF THE CIRCUTT COURT. • i'
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ST. LUG 1 E cptnr~y. ~-i,pRmA; •
Tlus is mr deelaratioa of DomieDe aad Citir.enship io the St~t,a of Floridt thst I am fl'sn~ t1~Is dy in accordaace. and ia ~
conformity ~it6 &ctioa 222.17. Florida Statutes. • '
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I w as fortnerl~ a Iegal resident of ~~ ~~ ~ , ~~~~~t^' • .~d I_ ,
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re s;ded at s 3 a D ~~ (~ i S~ // V E•~. , However. I bave ebanged m, domidle to ~ ~
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and nm and bs~ e beee a bona fide resident oi tbe Stat~e of Florida since aU ~ ?
-f ~ • .19~ and I reside at ~ ~ ;L ~ ~ /~~ ~---~ { ~ ~'~ `
' .~"~. ~+ J G/~ ST. LUG 1 Est~.t.~N~~ ~unt~. Florida. ~
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and this statement is to be taken as my declaration of citir.enship, aetual legal residence snd domieile in tbe Stat~ oi Florida. ~
' I F FOR YHE PURPOSE 'OP EN`ROLL ING
GHILDREl1 IN SCHOOL~ PIEASE STATE
?HEIR NAl+IESt
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• IF FOR H6MESTEAD'PURPOSES~-~
P~EASE CHECKL ~_ ~}'
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1981 JAN 29 AN ~~ SS
F~~.cc-~nc ~~coaarn
5 ROGER POITRASa ~
CIERK C{RCUI ~ CO'JRT
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515191
~ I FLJRTHEA CER1'g'Y that I~l register at m~ Iocal address ~vben the registration books reopen. u~d comp~ ~vitb aII
~ other requiremeats cd a 3ega1 resident oi this State. . -
I FU~tTHEH CERTII~'Y that I have no inLention to seRarn to na~ former domieDe, ind I intead to remsin 3a
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~ F'Jorida. permaaeasi~.
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j-}RNeld /~1- ~'o~pe . . .
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s~ orn to u,a snbsen-bca beton m~ t~s a 9~ a,q ad
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ROGER P~31 TRAS, CLERK OF C IRGUi T C0~2T
ST. ~UG 1 E COUNTY, FLOR 1 OA •
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