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3~6241
TO THE CI.EAK OF THE CIRCUIT COVIiT.
ST. L UC 1 E ~pU~Ty. ~,p~A:
Thts Is mr deelaration ot Domieile aad Citheaabip ta tbe Stata ot Fbrids thac i aaa ~ this dap in aooordaaos. and in
ooafoemit~? with Seetion 222.17. Florida Statutes. •
I was f rmerl a legal resident ot L~~''~f , ~ / U at~d I
IAVf t~at~
resided ~t ~~c% /'PS ! However. I bave eAaaged rqy domicile to
(~ewt ~sd N~b~) ~
aad am aad bave beea a bona i'ide resldent ot ths State of Fbcida siace day ot
~~,~..~9
~ and I resjde at ~Sn L~'1~tl.Gt.J' D ~v G~
(8hwt aad NnmDK) _
~i~T e: E- - ~ ST. LUG I E ~ Couaty. F1orlds.
(~s)
aad thL+ statement ia to be taiced aa~ n~y dee4nUon ot citjseashlp, actual kgsl ra~ideaoe aad domieUe In the State of Florida.
IP POR THE PURPOSE Of ENROLLING IF FOR wONESTEAO PURPOSES~
CHIIDREN IN SCHOOL~ P1.EASE STATE PLEASE CHECKS ~
THEIR NAMESS
~'~Q C'~i r~ c J
dO~'r /'7~z~pf~~ _
. ' =T
IUCiE ~OVIfTY~~~,
IIOCfR FOITRAS
~ ClERK C?:.CUIt CObR1
RECORu YEF~~IEO ~
- ~ s~ e ~i 2~ ~ ~r5 ~
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I FURTHEP. CERTIFY thAt I will register at my local address when the registration books reopen, and eomply wich all
other requirements oi s legal residenl of this Stste.
I RTHER CERTIFY t at I have
no intenlion to return to my tormer domicilc. and I intend to remain in
c~T cS~ T ~dC/E- , ST. LUCIE ,Counly,
ICit~) .
Florida. pcrmanenci;.
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,Q Addrea)
Sworn to and subxn'bed before me this ~ dsy of ~ fT C/~
- . A.D.19 7S ~
ROGER P01 TRAS, CLERK OF G IRGUI T COURT
ST. LIJG 1 E COUNTY, FLOR i UA
BY:
EP TY E
goox 243 PAGE ~.337
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