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D~c1ac-ation afi ~o~~~:'~ ~4~i~.~~~:~~~;~
:c~~ri~r ~~:~~rf::~~~r.~c•uv~-r~••~~.~xnstii~s5c~it. . 26~*~8
St .I.l2C 1@ 4
_ _ - CY~l1N'I'Y. l~LOftll)A: ~
~
77~i. i~ my clrcl:~r:~ti~~n c?f Uomirilc ancl ('itizrnslii{~ in thr Stat~ ~f 1=lurida tts::t 1 a~u fili~i}: tl~,: ci.:~= i~: i
arror~i;~n«, :inc! in c~~nfonnity with S~ction ~~'.17, f~lorida Statul~,. •
,
I~v.~s forn~erh• a I~gal resiJ~'itt of ~~j~. ,---~/?1~11~1_---- and 1
cc~~y~ (Siste)
r. sid~d at -~'d,~T ~ ,~r'~_____-_----_. . Howev~ r. 1 havr CI1311€l'(~ my ~umi~ile to
- (Street and Dium rc) • .
:tnd am and }1JY~ lxcn a bona fidc rrsidrnt uf th~ Statc of Florida since _~_1f _ da~~ oi
/ now ;
~l~l , 19.~_, and 1 ~reaidc at .~-~-~e-~!~.~--~~~ '
. ~ <s~.cra s~~a !~umbc~~
Luc ie
°r~~f' J , St • Coanty, Florida, ?
(city) ~
and this statr?nent is to be takrn as my declaration ~f citiren~hir, act~ial legal msidei~ec :~nd domicile in tlie State
of E=loricia.
(lnseri herr anY ~«n~nt tacts, such u wle ot prujxKty or businrss, or retinquishment of empto~ment at (ormer
domicile~ re~nosal of tamiiy to new dumicile, putchase of home, etc_)
'1~
Entering children in school: ,C~~ y~~ f~~y.~~ ~
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rn.~,~~c ~a
f T. LlIqE C~ ~
CIER~CIRC~WT
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RECORD rER~F~fO,_..,~ v ~
~ t~l ~ oi ~I!'t3 ~
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26~g _
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' ! FURTHER CERTlFY tl~at 1~vill rcgistcr at my local addrrss ~vhcn thc rc~istration bookt rco~cn_ ar.d '
f comply wiih xl! dthcr reQuirements of a Ic~~al r~sident of this State. .
~
~ ~
I
E I FURTHFR CERTI~Y that 1 ltave no intcntion to rct~irn tu m}~ forn:~r domiciie, and I intend to r.m.~in ir. ~
` ~ St . Lucie ~
; f ~T ~ r°~~~---- - ~ , couniy-
; Flarida, permanently. ~,(o.,~~~
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= G~i~ Q (!~am ~
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~•s~.~~~`~ ~ A.n, r _ 73 . f
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~ ~°~E~~'~~~,Q~~t~1S, I.ERK CIRCUIT COURT
- - - _
~ 6 R~ 7 P116E~: ~ ~7J
~Y lleput~ C1 l _ _ 00lc
(To M e~eculed in Jupb.,ir ..~..t ~~n~mal.f~irJ ~~~li~ <'ir.l, t'~r~ ~iit 1~~~rrl. .rnd ~+r.t+It :Ac t~~tL .A`.us~wu) t
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