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T0771E CI.EItK OF Til~ CIItCtJIT COU1tT. . .
--ST. I.UG 1 E COVNTY. FL01tl~A: .
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7'~b b apr dalaration ot I~akib and Cithea~hip in tl~e StaLe ot Fbrida t!w?t I am C~l'~pa tAts dy? ia ~aadanes. and te
~oatorwiyr ~?ith Soettoa 222.17. Fiorida Statutes.
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I w~s t ~m rir ~ k al resident ot - . ~-~nd I -
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resided at _5~11_.lY• S T - No~rever. I~ave ehanaed a~r domiei7c to
ts~n.e..e Nme.r1 .
t0~ ~A1 ~AtI ~~0 bEdA i bOfla ~Q TlS~CA~ O~ ~Ile S~i~O Ot FIOi~i i~fliA ~?r ot
~ ~ ~ il~.. and I reside st ~ o~~ S7,
~e.t~r 7"~~,pG.E, ~ tser..e..a H~1 ~;r. -
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aAd tAis statemeat ~s to be takeo as mp dectaratjoa ot citiYenship. aetu~l kg+~l rosideaoo aud domte~e in tho Stata ot FloridR.
If POR TNE PURPOSE OF ENROLLING IP POR HONESTEAO PURPOSES~
CHIIOREN IN SCHOOL~ P~EASE StAtE PLEIISE CNECK2 ~
tHEIR NANESt -
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I FURTHER CERTIF'Y that I will register a! m~r local address when the registration bo~ks reopen. and comply with all
otber reqnircments of a kgal resideot o[ tbis State. -
I FUIiTHE.~ C,~IiTIF'Y that I bavc no int~ntion to return to my formcr domiu'le. and I intend to rcmain in
~D~Q EJ/ E Jt~~E ~ $ T. L U C 1 E . County.
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~tOG R P01 TRAS, CLERK OF C IRCUI T GOU2T 344524
fi~EO ~?MO aEe RoEo
~ ST. LUG i E COUNTY, F ~OR t UA • ST. LUCIE COy~ir F~~. - -
• ROCER POITRAS .
' CLERK CIRCUi~ COU~T~/~
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