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D~clara$ior~ of D~miciQe and Ci~iz~nship
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TOTIIECi.ERKOFTlIECIRCUITCOUIiT, ~ 32C2tj~
ST. lUC 1 E CpUM'~'Y. F'[,pR10A: .
. '1'hts b my dcelRration ot nomlcib and Cll~onship ia tM SU?te ot f'lorida tluit I un Cjllnt tA4 dyr ia aeto~daaee. and in
~oato~anitr with Scction 2~.17. Flocida Statueos.
1 ~?as torm~rl a Icg~! ~aideat ot ~/C /~h'I / ,~Gf 9C , C I~7 /7 , ~ and I •
, ICtt]?1 tstatd .
iesWed at ~7' Lv D B L°- - Howe~te~. I 6ave ehapged mr domicilo to
IStn~t and No~l • .
sad aa~ and have bcca s bona C~do resideat o[ tho St~to o! Fbrida sioce day ot
19.,' ~ . a~d I reude at (~Gl ~ - „~j~~
~ r-/ y- l&r«t wd NYOserl
, V t° Y~ ~a~' h/~ L G C ~ ST . LUG I E Councy. FIoT~a., k
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aad this statcmcnt u to bo takea a~ my d~claralion ot eitisenahtp. actual kgal reeidenee and doaaia'le in the Stato ot Florida. -
If FOR TNE PURPOSE OF ENROLIING IF iOR HOHESTEAO PURPOSES~
CHIIOREN IN SCHOOL~ PLEASE STATE PLE/lSE CHECKS ~
tHE1R NAMES:
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. - ' f?~FO ~NO RECOacEo
. ST. LUC1E COUJ~TY Ey,
. ROC,R POITRAS ~
CIERK C~RCUIT ~pURT
. ~ RE~G?.) VfRir1ED
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~ I FUItT11F.R CF.RTIF'Y ihaL I will rc~istcr al my local address whcn the registration books reopcn. and eomply wilh all
~ other rcquirementc o( a Icgal residenl of tt~is State. ~
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~ 1 ~y ItTlf :t ERTIFx lb~l 1 t~ave no inlcntion le rcturn to my former domieilc. and 1 inlend to rcmain in
1'~'Q G~~P ~-CJ~jf'/ .7r°rs~r .~c , ST . L u c ~ E , c:~~n~y.
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Florida. pcrmancnti; . ~
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~ Sworn•to nd iebtierihcd h~•!oro mo lhi+ Q~,~,~ day ot ~j"~ C' C l.~ I~ / C'tJ~_
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~C~R f'O _AS„ CI_Ff2K O~ C IRf,UI T COURT
~ St. LUG I E COUNTY, f I.OR 1 UA `
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