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• ~ 31.~1
TO TliE CL~RK O~' TNE CIRCUIT COURT~
ST. L.UC ! E _,~,;:,C+pU~y. ~,,pRIDA:
Th3s is my declaration o[ Domicile and Cltiscnship in tbe State o[ Florids that 1 am ping this ~tay in accosd~neo. and in `
contormity wilb Ssctton ~2.17. Florid~ Slatutes. • ~ ~
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l waa farmort a legal residcnt of and r
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residcd ~t ~ Howevcr, I have changcd my domicile to
l~+ee! aw! Nua~bsr) • -
and am aed h~ve been a bon~ dc rrstdent o[ the Stato ot ~'loridi aince - day ot
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f9 d I restde at ,
? (Strw! sad Number? ~i
' ST. lUC 1 E Couaty. Florida,
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nnd this statcment is to bc takcn as my declnrAtion of citizcnship. actual legal residenee and domicile in the Statc oE Ftorida,
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IF fOR THE PURPOSE Of ENROLLING . IF' POR HOMESTEA~ PURPOSES~ ~
CNiL~REN IN SCNOOt,~ LEASE STA7E PLEASE CHECK: ~
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I FURTIIER CF.RTIFY ihat 1 will re~i~tcr at my local address whcn !he registration books rcopen. and con-ply ~+rith all
other rcquirements ot a Ic6al reside~l o[ tt,is Shate.
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I FUR '`t IT'Y h intcntion to tclurn to my (ormcr domicilc. and I intend to remain in t3
~ $T . U C 1 E , Cuunty.
(Cityl . _ ~ .
Florida. p~tmancnti~.
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Swo~- nnJ subsr.rii,ed l,~fc~re me tfiis . day ot ~•(.-~~.GP
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.~f~ra r~ _ i-rr~ns ci_E i:K OF C I F:C.U t T COUtT
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ST. l_UC C COUNTY, f t CN21OA
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