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T01'1iE CLERK OF THE CIRCUIT COURT. 316~,40
ST. LUC 1 E ~p~y~ ~,p~pA:
This is my deelaratioa ot I)omlcib aad Citisenahip ia the State ot Florida thst I am GIIag tbis dq ia ~ccoedaaee. and in ~
toafocmity with Sectioa 222.17, Fbrid~ Statute~. ~ ~ ~
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I ww i rnnerl a kgal ebsldeat ot and I '
~1/~ 1~?/~.fy/L~ f ~?J ~ ~I,C,tt7) l ~
i~ ~~a~""J Hwvever. I bave cbanged my domicik to
lst~..c wa N.~oe.r~ . i
and am and have been a boaa fide resideat ot the State ot Florida sincs ~i~ ~ d~? oi
~_.19~ and I reside at ~ ~~`f'~rf %e~'raC~
rf s't LttCie ST . L UG I E~ ~,Atr.
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and this statement is to be takea as a~y deduatk~e ot eiiizea~bip. sctual legal reaidenee u~d domict~e in the State d Fbrida.
Ii FOR THE PURPOSE Of ENRO~LING If fOR ~IOMESTEAO PURPOSES~
CHII~REN IN SCHOOL~ PIEASE STATE PLEASE CHECKS ~j%~'
THEIR NAMESt ~=~1
8T
lUC1E CO!!Nn F~A, .
R~?CEI~ FOtTR4g
CLERK C: :CUIT GOURT
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. Sfr 8 t f oa AM '75
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I FUBTHER CERTIFY that I w~l register at my local address when the registration books reopen. and compl~. with all
other requiremeats of a lcgal resident of this State.
I FURTHE, CERTIF'Y that I have ~o intention to return to my former domicile, and I inlend to remain in
~O'i"~ ~/i L~IC i~C. S1' . L UC 1 E~ , County.
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Fiorida. pcrrr~anentl~ .
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Sworii.~ ~ `d betore me this dsy oi 1 C~ fy~~LcP.+._f'1~t~ a
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ROGER I TRAS, CLERK OF C IRCU1 T COURT '
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ST. LUGIE COUNTY, F~ iDA
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