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Dectaration of Don~ic~le and Citizenship ~
' 515698
TO Z'HE A.ERR OF THE CD~CUTI' COUliT.
ST. LUG 1 E ~pv~y. ~,p~~;
Tids fs m~ deeluatioa ot Domidle and (~tiunship in tbe State of Florida that I aan flint this da~ in uoordanae. and i~
eontormit~ wlt6 Seetion 222.17. Fbrida Statutes. ~ -
~ j.vas lormerl~ a kgal resident ot •~aC ~i c ti~ v r/~e. ,~- ~c~r ~ ~~ ~~-- ~d 1
1~) (8taW .
ns~ u H> ~~l~ L~ y? a~ P k~J Ho+vever. I bave e~ng~ed m~ domide to
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t8te.~t aod N~b~ - ~
aad am and have been a bona Sde nsident of the SWe a~Flori3a siaa ~-~ ~~~ ~~ ~
~" .19 ~~, and I reade at 3 D C~ I A~~ a~ S V-
(Str..~t aed Plnmb~rl
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and this statement is to be taken as a~ decluation a~ atizenship, actual kgal residenoe and domjdk ia the State d I~7o~t f
" I P FOR THE PURPOSE 'Oi ENROLL INC I F' fOR HOMESTEAD- PURPOSES~ -
CHILOREN IN SCHOOL~ PIEASE STATE PIEASE CHECK: ~~
THEIR NAMES: ~
r-
' 1981 FE6 -3 AN i~ 51
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51.LUCIf COUYtY.F[a.
RGGFR POITRA5
C:.ERK CleCU:T C:~U~ ~ _
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515698
I FUR1~ CERTII~'Y tbat I~viq regist~r at m~ 1oca1 address wben the registration bool~s reopen. and eompb ~ aD
otber reqnir~emenb d s kgal nsident ot this Swe. ~
I FUIt'I'f1ER CERT~'3C ti~at I have no intcntio4 to retmn to m iqrmer domieDe. and I intend to remain i~
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; ~- P~~RA~t CLERK OF C IRCUI T COC~2T
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