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TO THE CLEAK OF THE CIRCUIT COURT. 3,~~ `
ST. l.t1G i E ~
, • COUtv1'Y. FI.ORIDA: • • • • • I
Titb b tqp deels~xtto~ oi Domieile and Citizeu~hip In ths 6tab ot ~'lo~ida that I un GIIa~ thb dar to ueocdaae~. ~nd in
coa6oelnitp witA Seet~ou 222.17. Fbrida Statute~.
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ewW~d at ~-a"n~ _L ~~t~c_~. --$ow~we~ I tuw et~ae~ed my domieile to
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and am aad luve been a boaa fide rssideat eithe Stata oiF7o~ida ~iao~ ~~e- /1' y~ ~
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• t~d thls ststeenent i~ to bs lakea as a~r d~claratioa o~ eitizeasAip. aetnallegal cesidaace aad doania'le ia tM State ot Ftorida.
IP fOR THE PURPOSE Oi ENROLLINC I!r ?OR HOMESTEAC PURPOSES~
CHILOREN IN SCHOOL~ P~EASE STATE ?I.EASE CHECK: ~
THEIR NANESS
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RE ~~R RK ~"~~UlT COURT
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I FLTEtTHER CERTIFY that I rr~l register at my loea[ addras when the registratioa booka reopeA. aad tomply rvith all
otAer nquirements ot a legal cesideat of this State.
I FUItTHE~CEF~I'IFY~st~ ve n$ intention to zetura to my tormer domieile. and I intend to remain in
$T . L U C 1 E . Count~+.
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Ftor~d~. permaneacl; . • ~
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6worn to ~nd ~ub~eribod befo~e me thb ~ dar oI ~ r,~_,, `~`l
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i~QGER POI TRAS. CLERK OF G IRCUI T COURT . ~
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ST. LUC 1 E COUi~1TY, f LOR 1 UA ~ ~
BY: ~
EPUTY ~EaK gpQX~4~ FAGf 3z8
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