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Rr~c~~rat~on ~f D~m~c~l~ and C~~~~~nsh~p ;
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TO TII~ CLF;RK OR THE CIItCUIT COURT. ~~O ~
ST. LUC 1 E CpuN'1'y~ FI,pR1DA: .
This ts my decl~~ation ot DomicUo and Clttzcnsbip in the Stato ot Fiorida that I am iDin6 this da~r in aeeordanee. ~nd in ,
conformity with Scction 2~.17, Florida Statuta~. - ~
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1 wu ta~~l k~al rcaIdcnt oi and I
1~71 fSt.te1 ~
resided ~t ^ y~~ Howevor. I have ehangcd my domicile to
I~t~e.t ~nd Nvmbed •
and am ~?nd havc beca a bona lidc srsident ot the Statc o! Florida stnce ~ day ot
-19~ ~nd I at ~
' tStreet u?d Numb~!
_ . ~ ST. LUG I E County. Florias.
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snd tbis statemenl is to be takea ~s my declaratiost ot citizenship. actual kgal residene~ and domieile in the State o[ Florida.
Ii POR THE PURPOSE Of ENROLIING IF' ~OR HOHESTE/lG PURPOSES~
CHIIDREN IN SCHOOI~ PIEASE STA7E PLEASE CHECKL
t IR NAMES:
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%J ` f~«o ~~t? Rcc~4~a ~
c~ ST_ LUCjE C~1~hTy F~A,
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fiE?i. C:'-:~;pT ~OJRT~`
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1 FURTIICR CF.RTIFY that I~vili rcgi~tcr al my local address w1~en thc registration books reo~en, and eomply with all
other requircments o[ a Ic~al residcnl o! ihis State.
I F,~T
1:t CERTIFY that I~ v~ no intcntion ta return to my focmer domicile. and I intend to remain in
~~`~.c~t.~~ , ST . L u C I E , C.~~unty.
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f ~'lorida. pcrmancnti; .
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~ Sworn lo erfd~~uJ~,~j~d'1~efuro mo lhis day of
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