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TO THE CL~;RK OF TUE CIRCUtT COURT.
ST. LUC I E Cp~y~ ~•LORIDA: '
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This fs my decleration ot noniicita and CitL•.enship in tho Stntc ot FloridA thAt 1 am ftling this da?y in accordanco. and in ~
conformity wilh Section 2?.Z` .1?. Florida Ststutea.
1 wu to~mc~ n lcgal cesidcnt oi ' and I 3
1Ctty! ~ / ~d ~ f %~se.tel ;
resided at _ `Yl G' ,CJ~L't.P~~~ /~lL1~C `?-~L ,.~ZLG'1'J'(-3'L~~~ . iowevcr. ~
. hnvc chsngcd my domicilo to ;
(Street u~d Numbe~I ~
~ad am ~nd hAVC bccn a boni fidc residcnt oi tl~e St~ic ot Florida since d~?y ot ~
.19~~. ~nd I tcside at • ~L~-~~G~
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' (Street ~nd Nuwber) ~
~ S T. L UG ! E • County, Ftorida. `
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end this statemenL is to be taken ns my dectnratioa of citizenship. aetuAl legal residence :nd domicilr in tAe Statc of Floridn. ~
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IF FOR THE PURPOSE OF' ENRpLLtNG If POR kOME5TEA0 PURPOSES~ i
CHILOREN tN SCHOOI~ PLEASE STJ17E PLEASE CH~CK; ;
TNEIR NAMES: ~
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1 FURT]ICR CFRTIFY tha~ I~vili regi~tcr at my locai sddress when lhc registrateon books r~open, and com.ply with al!
othcr requirements oi a lcbal resident of t!~is State.
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I FURTIIEd L•'R lhat I have no inttntion t~ return to my tormcr d~miciie, and I inten~ to remair. iu
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_ ~ , ' ~ _ ~:,~if~C~.. ~ ~ $7 . U C 1E . Caunly.
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I~?orida. pcrmancnti;. F~L.EG R4E Ki{; n 0
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Sworn la++ttd sub~criLcd bctur~ mc this dny of ~~C~~-
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Rn('a1:R _NO! TR~S,~ G~~RK OF C IF:CUI T COt~2T
ST. L UC I C COUNTY, F L.OR 1 UA
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