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I TO THE CI.ERK Ol~' THB CIRCUIT COURT. . ~
~3~'~839 ;
ST. L UG 1
E ~pvrrty, FI,ORIDA: ;
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This i.i my declaration of Domicilo and Citiscnship in the State ot Florida that I am tilfag thi~ day in aeeordance. ~nd in
coaformity with Scction 222.17. Fbrida Statutes. - ,
I wu torm~rl a le al resident ot t~l`t C~`~ ~
g ~ ~ ~s and I
residcd at - S~ L~l ~C--~ L'~ However. I havc changed my domicilc to
ISt+Mt ~ud Nu~nber) -
and am and have bcen a bon~ Cde resident ot the Statc o: Flotida since _ d~~J day ot _
_~T~ L ,19~.5.,.. and I reside at O` ~ L~ Q~2 ~ ~
~ Numeer1
~f' F ~ ST. LUG I E County, Florida,
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and this statement is to be taken as my declaration oi citizenship. actual legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING If i'OR HOHESTEAO PURPOSES~
CHILOREN IN SCHOOL~ PLEASE STATE P~EASE CHECK: ~
THEIR NANES:
~Z~~~ 3~~,83 r _
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F~IED r,~,. ~~CGR~EO
ST. LU.Ct_ CG~MTY FLA.
~ ~ 'J~?FAS
! ClFRk. ; ;;;;tT COITRt
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. Mar 11 f o3 PH'1
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I FURT}IF.I~ CF.Ii1'lF'Y thzi 1 will r~~istcr nt my local address when thc registratioz~ books reopen, and comply with all
othcr requiremcnts o[ a Ie~;sl residet?t ot thiti State.
1 FURTIlG:t CF.~?TII'~' th, t I hav~ no intc•ntion lo rctur~, to my [ermrr domiciic, and 1 in:cr:d to remain iu
- - - - ST L U C 1 E (:~~unl}•,
(City) .
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