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TO TIIE CGkRK OH' TIIF CIRCUIT COURT. ~
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ST. LUC 1 E COUNTY. FLORIDA: ~
This is mr decldration ot Domicile and Citizcn~hip in the Stuto ot Florida that I am titing thi~ day ir~ accordanco. and in
eontormity with Scction 7~.17. Florida Statule~. '
4`.(1w..~C ~ ~ I andI
1 was tormcrl n 1cEa1 residcnt ot - -
, (pt lSt?tel
cesidcd at ~ 5~ ~ . 2lowovcr. I havc changed m~ domicilc to
(Street and Numbsr) '
snd am A d havo bc~n ~ bon~ tidc residcnt ot thc Statc oi Fiurid~ sinec dsy of
19~ and I reside at ~ ~
(St~t and NumEer)
~i lQ1Lt'.Q ~ ST. LUC I E County, Florida,
ca~~~
nnd this statemenl is to bc tslccn es my declaration oi citizenship. actual legal residenee and domicilc in thc Statc ut Floride.
If fOR TNE PURPOSE OF ENROLIING IF FOR HOMESTEAD PURPOSES~
CIi1LaREN IN SCHOOI~ PLEASE STA7E PLEASE CHECK: rT~~ -
THE IR NAMES: ,
- jt~.[~ c.? ; ED V'
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I FURT3IER CF.RTIFY tha~ I wi11 rcgi~ter at my local address when thc re~istration ba?}:s reopen, and comply with all
utncr ta q~iremcr~ts of a Icgz! rasid^at n; lhic Stat.•.
~
I FURTIlE;t CERTIJ'Y that I havc t~o inteniion to return to m~• formcr domicilc, and I intcnd to remain io
• $T . L U C 1 E , Cou~~ly,
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F'lorida. pc~rmancn~i; . _
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S~vorri
t~~±~t~~t13?s~ribcd lKiorc me lhiY dny of L~' ~ V~V~J~i~-Q- o -
A.1). 19__L~
RnC~fR 1 TRAS, CLFRK OF C IRCUI T COt~tT
ST. LUG I E: COUNTY, f I.OR 1,UA
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