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TO Tllt: CLk;1tK Or' TtIE C1RCUIT COURT,
_ ST~ I.UG ! E COUNTY. FLORIDA: . .
9'his Is my dccla~~tion ot non~icile and Citizcnahip Ia tho SMto oI l~`lorid~ llu~t 1 am tiling thi~ d~y in aeeord~nco. ~nd in
conformitr witA Scction Z'2.17. Florida 5tatutca. `
I w~s torm~rl • Icg~l rca~dant of --f' y' ~ad I '
~ ~ ~ lSt~te)
residcd at ~ liowovc~. I hAVC ehangcd my domicile W
(St~eel ~nd Nuzree'1 •
and ~m ~nd luive lx~ea ~ bon~t fidc residcnl ot the Statc ot Flurida sinco ~...Q dRr oi
~ !9 ! J - ~nd 1 residc ~t T q ~,.1" t _ ~ '
~Stre~t ana Numbe~)
~p~ ~~~J" ~'E~ _ ST. LUG I E County. Florias.
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and this statcment is to be tsken u n~r decL?ration of citezcnshi{~. actual legsl residcnec and domieilc in tho Stute ot FloridA.
If F'OR TNE PURPOSE OP ENROLLIN6~ - IP ~'OR HONESTEAD PURPOSES~
CHII.DREN IN SCNOOI~ PLEASE ST/l7E P~EASE CHECK: t
tNE IR N/1MES2 ~ ^ ~
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FILEO AM~ RECQAOEO - ~
~ 1 ~Y . =t.1~UCtE COUMTY FLA.
AaCER P3~YRAS - ?
~ ' ' CIERK Gt.:CUIT COUAT i`
L~~Q_- L11~ ~l/ Rf.CQ~~i V~qIF1E0~~ ' E;
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I FUR7'lllsR CF:RTIFY ihat I~vill regi~ler at my local address wl~en the rcgistrztion Uoo~:s reopen, and comply .vith ali
oi},cr rcquircmcnts ot a lcyal residcnl ot this Statc. '
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l FUItT]iE;t C• RTIr ' thal I l~avc no intrntion ta rr.turn to my formcr domicitc, and l intend lo rcmain in ~ j
_ ~OR ~~%_~~CQ~ ~ ST. LUGlE ,C~unly.
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~iK~orn la nuJ subc~ribed b~•tu~ a mo thix ~ cley ot
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