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~ ' 315423 ~ •
TO THE CL~;RK 0~` THE CIRCUiT COURT;
_ ST. LuC i E oovrrl'~r. ~.o~unA: ~
This is mp decianttoe ot Domtetle and Citheaship ~a tbe State ot F'loejda that I ani t~ Ikis da~r in aceord~nee. and te~
ooatorm~tr with Seetton 222.1T. t'lorida Statutes. ~ ' ~
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1 w~ to~ a kgd residopt oi ~ ~ I~
. it,~ji i~Yatsl .
r~sid~d +?t' `~1V ~
R- - - Howevcr. I have ch~?nged mr docnicilo b
~&iwt ud N~ber) •
aad am uid h~ve beeA ~ bona tide r~sidcat of the Stato o! Florida siace ~1C~ U ST : Z_
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, 19.1,1,~ aod I reside at ~9 Z~e ~S"R ~o__~e~~.~'
~ lSt~wt aad Nu~aar)
~T LJc.? C_ ~ ST. LUG 1 E Couaty. Florida,
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aad lhis statement is to be takea ~s aqr decLration oi eitIunshlp. actual k~l residenee aad domie~c in the 3tate ot Florida. '
IP POR THE PURPOSE OF ENROLLING . IF i0R NOHESTEII~ PURPOSES~
CHIt~REN tN SCHOOL~ PLEASE STATE ~P~EASE CHE'CK: ~
YHEIR NAMESS .
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315423
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I FUR7'NER CFRTIFY that J will regi.~tcr at my Jocal address wl~cn the registration books r~wpcn. and co~r:ply with all .
other rcquirements o[ a legal resident of t!~is State.
FURTI~E~ CERT~'Y that I have no intrntion lo return to m lormcr domic~'le, and I intcnd to remain in
~`r~ S T_~ ~ ~ ~T . L U C 1 E . Cc?unty.
fG~rl .
~ Florida. permancnti; . ~
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~ Sworn to nn~'~u~f~d ~~etoro mo thi.v day of
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~ ROG~R F'O AS GLERK OF C IRCUI T COURT
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~ ST. ~IJG I E COUNTY, f L.OR t,UA
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g - ~PUTY LEItK ~
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