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Q~c~~r~$~~n ~f D~r~t~crle ~r~d C~~'z~nship
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TO THE CI.~;iiK 0~ T11E CIRCUIT COUItT, ~ 32~2• -
ST. L l1C i E ~pU~y. ~,p~DA: ~ .
Thts i~ a~y dcclanlion ot l~mktto and Citlzcaship~in tbe St~te ot Florida thaR I a~n [iling this d~y jn actordanee. and In .
eoatormity with Section 2r1.17. Flarlda 5tututes. . ,
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l w-as formcrl ~ kg~l rcaidant of ~`r- V/~'eC~~ aad I .
ICit71 lStatsl .
rrsided at ~T ~ S~ - I~owovcr. I haro chaaged mr domicile to
_ lStec+t and t~lwsn~) • - .
~nd am ~?nd havc bccn a bona lidc rcaidcat o[ the Seato ot F'lorida since day o!
/r/1i9i2 C~' , ~~7 . ind I reside at ~T .~os~
(Ste~t aad Numeer)
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~pCE= ST. LUG 1 E County.Florid~,
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And lhis statcmcnt is to bc tulccn t4s mp declAralioa af eitiunship. actual legal resldencc and domieilc in thc State oi Florids.
If F'OR THE PURPOSE OP ENRO~LtNG I~ fOR HOHESTEAO PURPOSE5~
CHILOREN IN SCHOOL~ PLEASE STkYE P4CASE CHECK: ~
YNEIR NANESZ
/t/o /1/~
Fq,~0 ~ND 3ECORQE~ .
fT.li1C1E COq~TY R
. qpCEK POtTRAS
CIERK Ci':CL•IT COURT
RfCOk~ YERtFt~i?
~ ~ FEe 1l 9 vs AM'76 ~
. 328392 ~
' I FURT}IER GERTIFY that I will rcgi~tcr al my local address when~the registration bool:s rcopcn, and comply ~vith ali
othcr requircmcnls ot a lcgal ~csident of t!~is State:
t I FURT]IE:t CERTIFl' ihat I havc no intcnlion ta mlurn to my farmcr domicile. and 1 intcnd to rrmain in
~ ' FT P/~`' /2C ~ ~ ST . LUC 1 E ~_,(:aunty.
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~ Florida. ~rmancnti~ . _ ~
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