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tion of Domicile and Citizenshi `t ;
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TO THE CI.ERK OF THE CIRCUIT COURT. 3241- :
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ST . L UC I E CpuIV'1~Y, Ft,ORIDA: '
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Thia b m~r declaration ot Domlcile and Cttiuruhip in the Stats of Florid~ that I am filiag this day in acoordaacs. and in !
coaformity rvith Section 222.17. Florida Statutes. ~
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I was fo~ a legat resident ot !
K~ h`~`r _ I n uJ CL- and I ~
1 tCi~1 ts~ata)
resided at ~ e S I~ e n However. I bave ehanged my domicik to
~ ~su..e,~aN~e.~~ nd
and am and !u?ve been a bona C~de resideat of the State of Florida ainoe - day ot
1) C~ A~~rt ~l ~ r ,]9_~ aad I nside at ~ ~ ~ G1 K e ~ r. J e.
(Ste~et aud Numba)
o:~ r c _ _ ST . L UG I E Couacy. b'~or;aa.
tCaV1
and tAis statemeat is to be takea as my deelaratioa oi eitiuaahip. actual kgal residenee and domicile in the State ot Fbrids.
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~ IP FOR THE PURPOSE OF ENROLIING I~ fOR HONESTEAD PURPOSES~ ~
CHlLOREN IN SCHOOI~ PIEASE STATE PLEASE CHECK: ~ i
t~tE1R NAMES2 ~
l~l i r~n~ ~ ~ e_ ~ r~ r~ - Y~ ~ irci~e r'
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w' r at m local addres~ when the re ' tralion books n. and com 1 with aU ~
, I FURTHER CERTIFY that I ill reg~ste y g~s P Y
~ other requirements oi a legal resident of this State. ~
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~ I FiJRTI~ CERTIFY that I have no int~ntion to return to my tormcr domicile. and I intend to remain in ~
'g ~or`~"' ~~e~rC~ , ST . L UC 1 E , County, ~
6 (Cit~1 _ ~
e s
~ Fl~rida. permanenti; .
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__,.L~dayoi ~or~ ~~~°r~c~z,,. ~Ior,
~ Sworir~,~d~ ~t~c'ribed betore me this ~ c~s~, 3 3. S~S a
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~ ` a ~'1 ic a r ~ A.D. l9
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y ROGER P01 TRAS, CLERK OF C IRCUI T GOl~2T
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~ ST. LUCIE COUNTY, FLOR1 A "
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~ BY' 6ouK~?~ 1 raGi Q~
~ EPUTY IERK
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