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'fiti, is ~uy chcl:+rativ~t uf Uun~i~ilc .~t~cl l.'il~i; n~hip in the Stat~ ot~ l~ic~ri~l:~ that 1:un lilit~~ ilii..l:?}! in
,icronl,~ncc. ~~n~i i» cont~c~~mity ~vith Srction ,".1 Flc~rid~t Statutrs.
I was formrrly a Ir,•al r~sidc~~t oi' ~A~ G~~ ,---.._..,~%1Y_..~~----------. an~t l
(Citf'j (Stalr)
r~sidcd ~t -----~f!,0~,-_°~a•3' llow~•vcr, I tt:ivc chaf~g~:d n~y domicilc tu
' (5tr~ai a~ed Nt~mArr)
and am ~and ha~c brcn a t~~tr,i fid~: rrs+dc itt uf il~e Slatc of Florida sincc day of ~
/ now_
---1~~--------- . 1 ~)__7`3, and l /resicl~ at --~a?_D
. ~ (StreM and IQwnber)
St . l.ucie
L ' ~C~'2~- . Caunty. t~iorida,
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and this statcmcnt is ta Uc takrn as my dcclar.ition of citizcnsiiip, actual lrbat rrsidenc~ and domicilc in the Statc
of Florida.
(bucn here any prrtinent facls, such aa cat. of proprrtr ur IIGSIRt'S5, or telinyuishment of employment at torme~
domicile, temo~•al of family to new dun~ic+lr, purrh;asr of home, r~r_)
Entering children in school:
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~ I FURTHER CERT(i=Y that I witf rc~ister at n~y loca! address ~vhen tl~e rcoistration books reopen, and ;
~ comply ~vith aIl other rrquircmcnt~ of a lc_~al rrsidcnt of this Statc. • ~
E I FURTI~GR CL-RTIFY th:it 1 I.ave no intention to rMurn to *~~y fornier domicile, and 1 intcnd to rcmain ;n t
` ~G~-~! , St . Lucie CountY,
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