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D~clara$ion of C~~mic~le and Citiz~~ship
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TO TlIE CLERK Ot' TI lE CIRCUIT COUIiT. ~ 3~ t
ST. lUC 1 E ppuNTY~ FI.oRIDA:
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.'~bls b mr dcclantioa of Domicilo ~nd Citisoeahip ia the State ot Fbrida th~t I am t~llns tAb day in ucordaaeo. and In
~oalo~mity wlth Scctioa 2~:.1T. Fb~ida Statu .
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i~?as fornMrl a kgal roaMent ot ~ . i~/(~. snd I
~ tpyl i~t~l
re~Jded at - H~w~ve~. I luve eha~ed a~y domie'lo to
18w.t..d N~e.r)
aad aaa a~d have been a boaa C~de resideat ot the State ot Fio~ida sines ,y~,~-~"~'t(1 e~ dar ol
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19~ and I seside at ~ r~~~ ~ '
• 1Stn~t aod Nue~e~) ~
ST. LUGIE ~
Cou~ty. Florida,
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sad thts statcmcat ia to bo Wcea u my deelarsUoa ot eitiueuhip. aelual kgal reeidenee and domieile in the State ot Fbrida.
~f iOR YNE PURPOSE OF' ENROLIING IF F'OR HONESTEAO PURPOSES~
CHIL~REN IN SCNOOL~ PLEASE STATE PLEASE CHECK: ~
THEIR NAMESt
fILEQ A~~ peCqAOEO n
=T. L1iCiE C~{t11'rj? F~~,
ROC~R .'0lTUS L
CtERR CIRCUit COURT
' pEC~R~ VERIF~EA
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I FUIiT1IFR CERTTFY that 1 will rc~istcr at my loca! addres~ when the regislratinn Iwoka reopen. and comply with ~Il
j othcr rcquirement~ of a Ic~;al residenl ot this Stntc. •
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I F t IIF;. CE1tTIFY tha h ve no intrntion lo rcturn lo my tormer domicilc. and I inlend to rcm~in in
~ ST . L U C 1[ , C:ounty.
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~ Florida. pcrmanenti; .
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~ Sworo to and ~ubscribcd h~~loro m~ lhis ~ day of -
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~ ROGf_R PO {__AS„_Gl_f.RK OF f, l RC U i T COURT ~ '
~ ST. LUC I E COUNTY, FI.OR 1 UA .
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