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ST. I.IJC 1 E t~OUNTY. F'L.ORIDA:
TNs b niy decfaraUoa ot Domieib and Citisenship ia the St~te ot Floeida tl?at I am 51ing this dqr in aocordanes. aad ta
ooatocraity with Seetion 222.1?. FlprWa St~tutes.
I was fo~ a legal resideat ot Q~~ ~~Q t Il~[1~ . ~~2
~~..~ll and I
(CIy1 tSat~)
reaidcd at 1~r lAg . -~iowever. I have ebang~ed my domicile to ~
t8tre~t a~d NwsM~) .
and am snd have been a boaa fide resideat of the State ~ Florid~ since -~~u day of
~1~~`/ .19~. uM I nside at h'~ ~ d 7~x ~s O L2/'°~ ~
. (Stn~t ~ud Nwnb~r)
=r-~ ~ P,E~ec ST. LUG 1 E u
- - Coubcy. F'~ocjda.
tCly1
and this atatemeat is to be taken as uUr deelaration of eitisenship. adual kgal resideace and doa~ic~e in the St~?te ot Florida.
IF POR THE PURPOSE OP ENROILING IP FOR HOMESTEAO PtiRPOSES~
CHILDREk IN SCHOOI.~ PLEASE STATE PLEASE CHECK: r`~
THEIR NAMESS
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I F'UftTIIER CERTIFY that I wilt register at my local address when the regis~ration books reopen, and comply with all !
other requirements ot a legal resident of this State. .
~ I FURTHER CERT FY that I ave no intention to return to my former domicile. asd I intend to remain in
~ "f ' ~i~R ~ ~ , S T . U C 1 E ~ . County.
l~tit~) .
Florida. permaneAtl; . _ - -
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;Swoi'M'/~btitd subscribed before me this dny oi
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ROGER P TRAS. CLERK OF C IRCUI T GOURT ' ~
ST. LUCIE COUNTY, FLORtUA
BY: ~l~n 1
U7Y LERK
~~R~ 243 Q~~E 205
• AGO Porm 91 ~22 .
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