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TO THE CLE1tK OFTHE CIRCUITCOURT. ' 3155!`'c.~ ,
ST. LUG I E ~p~y. ~,p~p~:
TlJs is m~? decl~ntba ot Doaiicile and Citi:aaahip in tAe StaLe ot ~'lorjda thst I un ti~ag this dpr ta aooo~daaos. aad in
contoraniqr with Sectioa 222.17. Fbrida Statutea.
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I was f rnnerl a kgal ra~i~ent oi c.. v j ~ ~ L S~,• ` ~ , ~ _
_ tpt~) 181at+~)
resided at ~ ~t ~n .Y. ~ t a... Z S• 3 - . Howevee. I 6sve ebanged aqr domie.ile to
l8t~wt a~d Nomeerl .
aad aa~ aad have been a bona ~de reaident ot tbe State ot Fbrlda siace t~-- da~r ot
~T
~+l•' ~ ,19_z.'~L. and I reaide at l~.o~t.,L,.~ r~~7tclss~ir. .Q
~..1 ~ia~_t"~-y~•
(BNwt aod Nuisb~d
F'a,~ T- 2 L i= ST. LUG I E Couat~?. Flo~ida.
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aad thia statement is to be takea as my declaratfon oi e~i~senahi~?. actual kgsl residenee and domieile ia the State ot Florida.
_ I f i0R TNE PURPOSE OF ENROLI ING I f FOR iiOMESTEAO PtlRPOSES~
CNiLOR~N IN SCHOQtt Pl.EASE STATE PIEASE CHECK: ~
THEIR NANES:
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lUClf COUMTy ~i~, -
• II~C~~ rQITRAS
CIERK L1:<CW~ CO~RT
~ROOk3 VF?:FtEA
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I FURTHER CERTIFY thst I will register at my local address when the registration books reopen, sad compty with all
other requirements ot a legal resident of this State.
1 FURTHER CERTIFY that I have no intxntion to return b my tormer domicile. aad I intend to remain in ~
l'd~t~ '~~rGu~ ~ ST . L U C I E . County.
ICit~) .
Florida. permanenti; .
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Sworn to and subscribed before me this day oi ~-v,~ (~_,u~,..;.t f-'~ oL 3~/ S~
E' . A.D.19. i ? -
ROGER P01 AS GLERK OF CIRGUIT GOURT
ST. LUGIE G4UNTY, f~ORtUA ~
BY : . , ~ .
P U T Y L f. R 1: ~QRK 243 PACE ~4~
ACA Fonn 71 22 '
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