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TO T~lE CL~;ItK OF TfIE CIRCUIT COURT. . ~ ~~~~4
ST. Ll1C 1 E ~ptTN'ry~ }Z,ORIDA: ~
This ts my dccl~ration ot Domicite and Cilizcnship ~n the Siato oi Florida thet J an? t'~ling this dsy jn accordanco. and ih
con(ocmity with Scction 2~.1T. Florids Statutes. ' ~
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J was formcrl a lcgd reaidcnt of ~.~U~ , ~~D ~ A and I
(t~yl ISt~tel
resided at ~~O ~ C Q t°Ee~1 ~t1 ~LcJ~ • /9i'~7~ , j;owever. I h~ve ch~nged my domiciie to
(&4net and Nu~Osr) •
and ~m ~nd hnvc bcon a bone lidc resident ot thc Stnto oI F`lorida since 2~ day ot
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s and I reside at ~ ~/~/C~~S' LCn1D ~f /T ~ ~
~ n (Stn~st wd Numbe~
/TiC3/5~ /~iA17: j'a ~ ~C ~QC~C~ ' ST . LUC 1 E . - County, Florids.
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nnd this statcmcnt is to be takcn es my declaralion ot citizenship. aciuallegal residenec and domiclle in tho StAtc of Florida.
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IP POR tNE Pt1RPOSE OP EN~OLLING . IP FOR HOMESTEA~ PURPOSES~ '~j~-,
C1i1LOREN IN SCHOOl~ PIEASE STATE PLEASE CHECKt ~ ~
7HEIR NAMES2
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i L£O AMD kfCOR0E0
S~ LtiC1E COUNTi~ FLA.
' . ROCCk ?J~TRAS
CLEAK Ct3CUIT CQURT
P.Er.~RC vEF~f,Ep
~ Jw. t~l i ~s PN'75 ~
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I FURTl1ER CFRTIFY thal I will regi~tcr at my I~,cal address v?t~cn thc registration books reo~en. and co~r.ply +vith all
othcr requirements o[ a 1c6a1 resident of this State.
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1 FURTI~E.t RTIF hat I have na inicntion ta rr:lurn to my former domicilc, nnd 1 intcnd to rcmain in s
~ eE?.Q. L-~ ~ ST . L U C 1 E . Cc.unty.
(City) . i
I'lorida. permancnti;.
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Sworn to ifirif~ ~itled bcfuro r~ie thiq .,.,=~:~-~,c--- day of l'~~/~ ~i.v ~/`v,e7~ i k' f.G•
~ n.i~. 75~ ~ C ~Il~O.J E -
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RnGt~f'~~POI7RAS. Lf:RK OF C 1[2CU1 T COUftT
ST. LUC I~ COUNTY, f I.OR 1(1A .
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f.PUTY LCItK _
• BOOK PACE
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