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TO T11E CL~;RK 0~ THE C11tCUIT COUItT. , .
, ST. LUC I E CAVt~'1'Sr. FLORIDA:
This is n~y declantio~ ot DwnIcile and Ciliacoship in tAo S~uto o[ Fiorids lhat I am qing this day in aeeordanco. and in
contormity with Scction ~2.1Z, Florida Statutea. ' ~
l was fo,rmorl k~ residcnt of ~ ~ and I •
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resfdcd at . Nowovcr. I hav~ cbanged my domicite to .
IStrwt Nuraber)
~nd am and havc bcca a bone fide resid~nt ot the St~?to ot Florida sime dey of
- l9_,_, and I residc at ~ ~ Q~,~ . ~ ~ ,
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ST LUG I E CountY. Florida,
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and this statemcnl is to be taken us my declaration of citiunship, aciual kgal residenee snd domicile in lhe State ot Florids.
I~-fOR THE PURPOSE OF ENROLLiNC If FOR HOHESTEA~ PURPOSES~
CHILOREN IN SCHOOl~ PLERSE STATE PI.CASE CHECKS ~
tHE 1 R NA1~1ES: ~
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~UC E ~OIEtNT~Y fU.
tiOGER F41Til~tS .
• CLEqK C~=:~u17 CQURT •
pECOFD ~~E~~t~eD
f~e 1l i ai PM'76
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! I FURT}IER CF.RTIFY that I~vill rcgi.~tcr at my local address wl~cn thc rcgistration books rcopcn, end comply ~vith all
other requiremcnts oi a lcgal residcnl of this Statc. -
~ I FURTIIE;t C TIFY that I havc no intention ta rrturn to my formcr domicilc. and 1 inlcnd to rcmxin in
~ ~~c 2L°_~c _ ~ ST. LUC1E .G.unly.
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}'lorida. pcrmanc•nti;.
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Sworn to nud subuuril,ed I?e(o~e mo thi.v cixy o( Q„ ~~r' ~ C~ : _
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~ ~nGfR__PnITRAS. CL~RI: OF CIRC_Ut'f COUtT • i
~ ST. LU~ 1 C CdUNTY, F~.OR t t)/1 s'
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