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TO TIIE CI.kRK OF THE CIRCUIT COURT~
ST. LUC t E CpUNTy~ F'I,ORIDA:
Tt~is !s my dcctaration of Domicite ~nd CIttzcnehip in the Statc ot Florid~ that I am filing tAis dAy in aecorda~eo. and In
contormity with Srction 2~.17. Florida Stututra. ' ~
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I was torm~rlY a Icgal resident ot ~~~~(1~ V~ ~ S , m i n Jl S C)~ d and I
, yr) lstate) ~
resided st ~ l~ ~V P ~r*~- - tiowovcr. I hsva eh~?ngcd my domicilc to ~
( Street ~nd Nv:oDs~) .
and sm ~nd hdvc bcen a bona fidc residcnt o[ the Stete of Ftorida since ~ ~^G'` d~y of =
,~Q. ~ (`t~t ~p 12 29~ and I reslde at o7 ~7 1'l. ~ - SLt M ir ~P ~ n ,a..~ ~
(Street a?d Numper)
~Q~ ST: ~.u c~ t ST, lUC 1 E County, Florida,
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~nd this statement is to be takcn us my dcclaration oi eitiunship. actual legal residencc and domieilc in the St~tc of Florida.
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IF FOR TNE PURPOSE OF ENROLLING IP POR NOMESTEAO PURPOSES~
CHILDREN IH SCHOOL~ PLEASE STA7E PLEASE CHECK: ~-"-"1
THE IR NAHES: j-~,~
~n~^ Ac.~ L 1~~c ~!t'.~1~
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f~~ ar7 ~ ~L~
it lti.'.t~ C~flAT~
lt6~~~ fOtf~t4
z1ER~ C~~~7lTCQl~T ~
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.~.1~ ~2 +?S ~N')5 ,
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1 FURT}IER CF.RTIFY that I witl regi~ter at my local address wt~cn the rcgisiration books reopen, and co~rply with all
uthcr requircments o( a Icgal resident of lhis State.
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I URT)iE:t CERTIFY that 1 havc no intcntion to return to my tormer domicile, and 1 intend to rcmain in
ST. ~.-ld C!~ ~ ST . L U C 1[ , County.
ICitY) . '
Florida, permanenti;.
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