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ST. LUC 1 E ppUNTy~ Ft,pRIDA:
Tbis b~r deelaration ot Doa~icile u~d Citiseaship ia the State ot Florida that I ua fillag this da~r ia ~ccordanee. and tn
coaforaaity ~rith Seetiau 222.17. Flotida St~tutes.
I was form~er~l a legal naideat ot ~~~1 ~~iu ~ ~ i1-~EU/ YA2.~ ~ I
, 1pV1 IState)
reaided at ,.,.~,~,,r • - Hmaever. l bave changed my doenic~7e to
/ (8tn~t aad Naa0K1
and am aad ?uve been ~ bona fide resideat ot tbe State ot Fbrida siaos ~_1 da,~? ot
E'~'T~i~,.•~1c=,t -19.yZS.
.~ad I reside at ~~~L. ~_E.~'Tir~~i1~~/.C~ C.~.~T `
. t8tewt ~ed Nvmbed
/~ivc2 ~y3~'t~v, ~o~~ ~~~`S1:L~~ ST. LUG 1 E Countr. Florida.
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and this statement is to be tskea as declaration oi citiuruhip. utud kgal residcace and d"omidle ia We State oi Fiorida.
IP POR TNE PURPOSE OP ENROILING IP fOR IiOMESTEAp PURPOSES~ '
CHIIDREN IN SCHOOL~ PIEASE STATE PLEASE CHECKL ~
TNEIR NAMES2 ~ -
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'~/O~/ SliG ,~~/.~liivT F ~EO At~p R~COROEb
LUCI~ GOi~NTY pl~.
aocEk po•Ta~s
~y/~~S ~G~.^,_,?/ ~t~T~ ~ . CLERK Cc'.~UIT COURT ~
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I FURTHER CERTTFY that I wil! register at my local address when the registratioa books reopcn. und tomply wit6 aU ;
other requirements ot a legal resident ot this State.
RTHER CERTIFY tbat I have no intention to return to my former domieile, and I intead to remsin in ~
.Srr LGG/E ST . L U C t E . Count
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ICit~) .
Florida. permaneaci; .
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Sworn to and su ibed befor~e me this ~v' ~ day of ~
' . A.D.19 ~
ROGER POITRAS. CLERK OF GIRCUIT GOl~2T
ST. L lJG I E COUNTY, F L 1 UA ~
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BYs ' ~ ~
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EP Y I.ERK ~
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BOGK 243 ~ 1257 AGQ Form ?l 22
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