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TO THE CLERK OF TNE CIRCUIT COUAT.
ST. I.UG t E oovN'rr. ~.OxtDA: .
T'his b m~r dedar~ttoa ot Domie~s aAd Citisewkip ta th~ Stat~ oi F7o~ida tbat I aai filiaa this dy ia a~oordanos. aad ia
~oatara~cy rritb Section 222.1T, Fbcida 8ta~ut... ~ ~
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I ~ras i rmee a kgal resid~at oi ~12X~ /YY~ O~/ ~712 aad I
~~~'~1 ~1 (stats!
resided at ~~~~u ia~~i~~l s However. I bave chsngad nyr doanieile b
t8tewt ~d Nwb~rl • -
~ad ata sad bave been s bons tids redd~ot ot tLs StaLe ot klorjda sina ~_7_„_~~ ~S dt,~? o~
~ 19~and I e~esfde at ~ ~J V
a~d Nwabe)
- Tf =~.Q~ 1~~Q ~ _ ST. LUG t E ~ Couatp. Flaida.
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sad this ststement h to be takea as m~? deelant3on ot eiti:ensbip. actud kgal tasidenos and domidle ta ths State ~ F7o~rida.
If FOR THE PURPOSE OP ENROLLING IF fOR ?IOMESTEAO PURPOSES~
CniL~~~n ~~:'•L'Cl.~ pie~cr e~~~rr P~EASE CHECK: ~
Y H E 1 R N A M E S: ~ , j,,,!_`~
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fILEO ~Np RECORDEQ
St. ~uC~E COUMTY F~,
' CLE K C fiClili~' C
URT :
. - RfCORD VEAtflfp'~ •
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I FURTtIER CEKTIFY that I~v~i ngister at my IocsJ address w6en the registntion• books reopen. and eompiy with all
other requirements of a tegal resident of tbis State. ~ -
~ ~~uI~ E8 CERTIFY t}ut I have no inttntion to retura Lo m tormer dorntc~er. and I interid to rcrosin in
yfT ``'2~_~Q_l~1.~1~...~ , ~T . L u c~ E . County.
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Florida. permanenti; .
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Sworn to Matl subseribed beiore me this ~ day of
- - ~ A.D. 29 ~ ~ -
ROGER P01 LRAS,,,_CIERK OF C IRCUI T COURT~
ST. LUCIE COUNTY, FLORIUA -
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- E UTY LERK
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