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D~claratio~ of D~micil~ and Citiz~n~hip ~
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TO TlIE CI.ERK Ot` TI IE CiRCU1T COUIiT. ~2~ 1.
^ ST * l UG 1 E COVNTY. F'I.oRt~A:
• 1'Mb b m~r dcel~~ation oI Domtcilo and Ci~~o~ahip ia the State o/ Flaida tbat I aun t'iUng t!~ d~y ia ~teord~neo. 'snd ia
~oototmity with Scetion ?.2..''.17. Flo~id+? Statutea.
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T~ U~C~ fOS~QQ~ O~ ~El~ O/~ _ N~ I.cJ y0 ~11d T •
a~ 3 G G y ST/Q~C KER R o/~ D - Howe~rer. I have cl,aaaed my domieilc to
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aad tat and Aave bcc~ ~ bot?a Cido resideat oI tho Stato o[ Florida since dj7? ~ ~
_ , ~N . l9_?~ . aAd I residc at .T_~~ ~ f f~Al ~ ~
ISuwt ~ad N~mb~~l
~a RT ST L v~ /G , ST. Lt1C 1 E County. Florida.
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aad thb statcmcnt i~ to be takca as asy dalaratioa ot eitiunahip~ aetual kgd residenec snd doraieilc in tho Stato ot F'locida. ~
IF i0R THE PURPOSE OF ENROLLING If FOR HOMESTEAO PURPOSES~ '
tHIIOREN IN SCNOOL~ PLEASE STATE PLEASE CHECKt- ~ {
tNE1R NAHESS
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i I Ft)lt7'iIFR CF.RTIFY thal I wiU rc~istcr at my local address whcn thc registration t?ook~ rcopcn. nnd comply with ali
f other requircment~ of a Icgal resident o( this Stalc.
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~ I FUItT11E:t CF,IZTIF'Y thal I i~ave no intcntion lo relurn lo my forn~er domicile, and I intead to remain ir~
, ~~~Qr" Sr ~Cuc~t ST. Luc~c ,C~,uniy.
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~ Sworn to nnd ~ubscrihcd hrtoro ma lhi+ dny ot _ f~T s r !/G/ FT .
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~ A. C f RK OF G IRCUI T COUZT '
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~ ST. LUG I~ COUNTY, F1_OR tUA ~
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