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TO TIiE CI,~;RK OF T11E C1RCUIT COUIiT.
ST. I.UC 1 E COUNTY. FLORIDA: .
1'his ta my dcclantion ot Qomlcilo and Cithcnship in the State oI Fiorida iha~ l~m t~ing this day in taordanee. ~r~d ia _
co~tormity with Sectioe 222.17. ~brida Statutrs. '
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residcd ~?t 3~ 7~ ~~l A t/ e~ _ l;owover. I have ehae~cd my domicile to
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and am and havo bcea a bon~ Gdc residcnt of the Sbta of Florida sime v 2 p~~•y of
l9~ ~ad I reside at ,l ~ ~ j ~1~' R.c.1 ~i/ ~ f~.n
lStre~t aad Numberl
~ e e~ C E' ' ST. Ll1G 1 E County. Florida,
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and lhis statement is to be taken ss my declaration of eitizcnship. actual kgnl residenee and domicile in the State of Florida.
IF F'OR THE PURPOSE Of EltROLLING . IP POR NOHESTEA~.PURPOSES~
CHIL~REN tN SCHOOI.~ PLEASE STATE P~EASE CNECK:
THEIR MAHES: • ~
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31538'7
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I FURT}tER CFRTIF~' that I will regi~tcr at :~y loca) addres3 when the registration books reopen. and comply with al!
othes requireroents ot a Icbal resident oi t!~is Slatc.
'i ]~UR IIE:~FRTIFY Lhat I havr_ no intenlion to rcturn to my farmcr domicilc. and I intcnd to rcmain in
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Swarn to nnJ sui?«ril,cd l~eforc nto ihis day of
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