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TO TtiE CLERK Oh` THE CIRCUIT COUitT.
ST. LUC I E CQUNTY~ FLORIDA:
Th~s is my dcclsration o( I)omicilo and Citizcnship in the Stato of Florids that l am fiGng this day in accordAnce. ~nd in
contormity vrilh Seclion 2~.17. Florida Stetutcs. - ~
~[JAiQSA~c,~ _ -,~.v13-~_ and I '
I w~s tormorl a Icga1 rcaident ot _
lCitrl lStatel
residcd at ~~a , ~1v~ . Howevar. I havc changed my domicile to
(Sttee ~nd NumDer) '
a~d am ~nd havc bccn a bona fidc residcnt ot the Stste ot Florida since ~ ~ day ot .
.19 7.~. aad I reside at l~~~ 7 '~~1 ~ F (,~J
. (Streat and Number?
~~e,e ~ ST . LUG I E County. Florida.
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and tt~is statement is to be taken as my declaration ot citizenship. nctual legal residence and domicile in the Stete of Florida.
IF FOR THE PURPOSE OF ENROLLING -IP i'OR HOMESTEAD.PURFOSES~
CH 1 LDREh 1 t~ SCHOOI~ PLEASE STATE PLEASE CIIECKI ~
THEI AMES:
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'fILEO ANL ~fCGkDED
ET. tUC,c _G~NTY F~A,
. ROv'f ~ Fu;7RAS t '
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I F URT}IEP. CGli1'1}~ ~ that I~~•ill rc~;i~tcr at rnp 1~x al address ~vhen lhc r~~;i ~:.ration boo~:s rcupc•n, arid compl~ with :?11 ~
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ot}~cr r~quircm~nts o~ a lc~;al residc•+it of ttsis Statc. - '
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1 FUlt7'lil;:i 'N7'IFI Lhst 1 hnvr n~~ in:t•n!i~~~ to return tn my furmcr d~micElc, anef I intcnd t~ :rt~iain i:~ ~
li r ~=-s r~~-~°- S7 ~-~__lJC i_E ,County,
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