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Declaration of Domicile -and Citizenship
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TO THE CLERK OF T}iE CIACUIT COUAT.
ST. LUC I E ~p~Y. ~,p~p~:
This Is mp declaration ot Domieile and Citi:eaship in tho Stats oi Ftorida tlut I aai filing 1hL dsy in ucordaaee; and in
eoatormity wIth Sectioa 2?Z.17. Fbrida Statutes.
I wu to~mer~ a kgal nsideat ot l ~i Q. U-Ke ~ ~ 1/V 1 S. ~ 3 a u 5 tad I
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resided at V U W• 1~ e S C~ c~ ~ C~~. _ Ho~rever. I have cbangcd my domicile to
(Str~et ~ud N ) .
and am and have been a bona Gde nstdent of the State ot Fbrida aince ~ g ~7 ~
~ e .19~ aad I reside ae ! 1~ v ~`'1 Qy ~ya.; r L~-
. i lStr«t ~nd Nwober)
I D?'t ~"1 ST. LUC 1 E ~,,,~y,
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and this statement is to be taken as my declaration ~ eitizeaship. aetual kgal residenee and doanicile in tbe State of Florida.
IF POR THE PIJRPOSE OF ENROLLING Ii FOR HONESTEA~ PURPOSES~
CHIIDREN IN SCHOOI~ PIEASE STATE PLEASE CHECK: ~
TNEIR NAMES: '
~~J`~
' fiLEO ANU RECOaOE~
ST.IU~~E CflUMTY Fl
RO . ER POiTftAS
CLCRK CI~CUlT COUR
P.f~OR~J YEP.~f~ED
- ~ Z~ 2 ~9 PM'16
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' I FURTIIER CERTIFY that I will register at my local address when the registration books reopen. and comply with all
other requirements of a legal residenl of this State. _
I
_--,I FURTHE,~ CERTIFY Lhat I have no intention to return to my tormer domicile. and I intend to remaia in
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l~ r~ ~~-f . i~ u r~~ e- - , ST . L UC 1 E , County.
f (Cit~1 . -
~ Florida. permanent,i; .
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Sworn to and suLscribed betorc me this ~ day of j a r~ ~ I• t- tt c~ e ~JQ j a ~
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` • ~ . , A.D. l9
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t ROGE~ .~PO! TRAS;~j~ClERK OF C IRCUI T GOU2T
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4 sr.: ;tiJG i E COUN~1~; _ FL.OR t UA
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