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TO THE CLERK OF THE CIRCUTT COUAT.
- ST. LUC i E,COU~t. ~`l.oltIDAs
Tl~is b aa~r dectiratba ot Ltoonieile aad txth~ahip ia th~ &a~e of F'lo~da that I am GI~~ ti~i~ da,~r in acooedanos, aid tn
eoatorwtlr with s«cton 222.17. t~loria. sN~t~Le..
I ~ras i rn~e a kaat s+estdeat ot ~ M.S~ n~ aad I
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rasided at ~ e~,~1.. Ho~rever. I hare ~6an6ed nV?
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il~ 1i1~ iDd ~110 ~a ~~OM l~i~OD~ Ot Ot ~Of~t i~A00 ~,~11 QM ~ a~ 1 ~ O(
19~..,.. aud I reside at ~5 ~ , -LL = ~ . ,
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aad tAb statemeM Is to be taken as m,~? dacLrat.ion e[ eltiseaabip, actwl legal reaidenoe and domici'le in the State of Florids.
IF fOR THE PURPOSE OF ENROLLING IP POR 110MESTEA~ PURPOSES~
CHILOREN IN SCNOOti PLEASE STATE PLEASE CHECKS ~
THEIR NANES: .
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I FURTHER CERTII~'Y that I w~71 register at my beal addres~ ~rhen the registratioti books reopen, aud comply w+ith al!
ot6er requirements ot a legal resident of this State. .
I ; CERTIFY thst I have ao int~ntion to return to my lorn~er dornieile~ and I intend to remain in
~4~I~r~j,,~, n t° 1 _ ST . L U C I E ~ County,
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Florida. permanenti; .
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Sworn to'and subscribed before me this ~ day of j~ r~7` A~~~y"
A.D.19~~
ROGER P AS C ERK Of C IRCUI T GOURT
ST. LIJG I E COUNTY, f ~OR i UA '
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EPUTY ICRK
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