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TO THE CL~RK OF THE CIRCUlT COURT.
ST. I.UC t E CpUNTY, FGORIDA:
This is my dcclaretton o[ Domieile ~nd Citizcn~hip in the Stato of Floride that I ~m fiUng this day in accordence. and in .
contormity with Section 222.17. Florida Statutes. ' '
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I was tormcri a legsl resident ot ' and.I
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residcd at ~ .~iowever. I have ehe~ged my domicile to
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aed am and have bcen a bons fide resident ot lhe Stato of F'lorida since ~-~Q = day of .
,19~. and I reside at 5 I ,
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Q~~Q ST . L UG I E Cou~ty. Florida,
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and this statement is to be taken ss my declaration of citizenship. actual legal residence and domicile in the State of FloridR.
IF FOR THE PURPOSE Of ENROLLlNG . IF' fOR HOMES•TEAO PURPOSES~
CHIl.OREN tN SCHOOI~ PIEASE STATE PLE/15E CHECK: ~
TNEIR NAMES: .
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i I FURTIiER C}:ItTiFY thal I~ti~ill rcgister al my local address w•hen thc r~~i;trEtion books rcoprn, and comply with aU
j uthcr requircmc•nit oi a 1^~;al residr.nl of lhis Statc.
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E I UftT l~::t CGRT11~ th: 1^I?a~•c ~~o intrritiun to rt•turn lo mp formcr do~nicilc, anc~ 1 in:cnd to rrmain in
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