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TC7 TtiE STATE <it+iD CQt1PVTV TJ-.)i ASSES,
.~ t ~ T.~i? C ~ ~ -- _._. Ci~t1P1TY, Ei„L.-fift?A:
Thia is my dada;ation of Domieii~+ aeu! Citixortahip in the Ststa o` Flot•ida that ! am filirog tt-ia day i:? ALCC!idar?et,
ar.d in conformity with Chaptsr 22'.2, Section ?22..1 T, f1'~cida St*h,teaa.
I waa fr~rnterly a legal resident of la~~.i~l~ RS~~~a - it~n£3.~ -"`
(City) (Saa»I
and I resided at t~' oLl'Ge ~.~ liQX. ,~~..~ hlcrvcver, I have cherrorrad my domicilt
t5~reet srx~ tdu.r+be•)
to +~nc± am and hav8 been a I~or~a fidt~ r~ssident of the State of Florida since _ ~.5. ~~ day of
ri'1o~llit 19 t?~., ar-d i rtside at ~~~ ~~.LAC'i~.~.~t1. 1.4L1T'~ _~ _.
(Strsst n+d N•~mbor)
FOT';. P3.~I'~~ - --- ~_..- St. .Lurie County, Florida,
(City)
and this stattment is to be taken as my declaration of citiaanahip, actual legal rtaidence and domitila ~in the Jtate
of Florida.
(insert Fwr• •ny par•.irwr~t ioets, wch u sad. o~ proF+arty or bwlrKU, or rsrifnq:r:s-srrgni of smepfa.+yment sr ioer:ter dtxnitiis,
nrwval o` fsKnEly ro new ~idls, purchae of homes, wc)
Enterinb :,n publiir school:
r:~agast John in 9th ~r~~e
..bi,~;~ti1 Guth ire bth ~;r:~de
i'a;;rici~:. J _ne in 4nd ~-rac.e
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I FUFTF9irR CkRTIFY that ! wii; rr~i~ter at trig i,:3cs; iaddre3s when ;ire re~istiativ~n L~ks rec)~~i, and comply with
ail othrr re~yuirements of a ls~u' rtaident of this CtLtG.
I FURTHER Crk ~ IFY that l have no i:r7tentic+n to resurn to rr.y fc,rrr~er d:-,r;sfciic, rr~f3 I int~nci try reman in
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