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Declaration of Domicile and Citizenship ~~~
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515~96 -
TO THE CLERK OF THE CIRCUIT OOUAT.
ST. LUG 1 E ppv~y~ ~,p~A;
T6is it m,~ deeLration ot ~omicDe aad Cltisans6ip ia t6e Stab ot I~lorida that I am IDin~ tMs da,~ ia aooo~rdanae. aad ia
eoatoTmitj witb Section 222.1Z. ~7orlda Statutes. ' -
~ Iwasiormes~akgalresidentot ~~ oF SPA~N ~,'N~OAD W~cr inoiEs andl .
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resided at ~ 1 ~/ 14.LE B E~ M O n+ T Tg/ N ~ Q~ However, I have cLanasd ~ domkile t0
l8tri~t aad N.sb~ ~ • ~
and am and bave been a bona fide resident of tbe Stste at Florida ainoe a T-+ E i G NT ~y d'
0 c-ro aER lg 80 ~d i~e ~ 5 5? S•~• T A niN E R ~y,~w u~
. 18t:..t aad Nnmb~el . .
Po~- $T - e_ u c~ E ST. LUG 1 E ~„~~ ~,~,~
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and thi~ statement i~ to be taken as m,~ declaratioa a[ eitizensMp. actual kgal residenee and domieale ia tbe State ai 'f7ocida.
' If FOR THE PURPOSE-Oi ENROLLiN6
CHILDREN IN SCHOOL~ PLEASE STATE
THEIR NAME8:
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Ii FOR HOMESTEAD"PURPOSES~'-
PLEASE CHECK: ~
S1S296
i~l JAN 30 II~ 11= I S
F~~EC RNC ~i COHI:f Z
S1.LUCIE COU++Fr.rta.
ROGER POITRAS
CIERK CIRC!!!T C4tlR
RECOMt V! P°~'E ~---- ~'- - -
I F[JRTHER (~iT1FY that I wiD register st m~ bnl address wben tbe registnation boots reopen, aod eompb wItti a~
other reqnireme~ d a kgat raide~ ad tbis Stat~e.
I F[JRTAEQ CEItTII~'Y that I l,sve no intcntio~ to retma to la~mer domie~e. and I intend to nmaia i~
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PAiR~C'iA ~cEUni~ Y~OHNE LEv~G
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~ 2 S. E- TANivER AuENUC- ~
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' Swoe~ to aad r~bs~bed befo~e me tbis J ~ .
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i ~R P~~R S C~,ERK OF C IRCUI T COC~2T ;
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~ ST LUG I E COUN7Y, fLOR t OA • •.
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9 ~~347 P,~1911~ - s .: M~ -
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