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~ Declaration of Domicile and Citizenship
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T(3 TNE CI.BRK OF THE CIItCUIT COURT. 3Jd31.'
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ST. Lt1C 1 E ~p~. Ft.p~~: ~
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• Tbls b a~? aeelu.uun ot nomieila .aa Gtiejsca~brp ia tb. sate o~ Fl~ia. w.t I.m mie~ tUb ay? in .eoo~+a.nce. ana jn
~oatocmity with Seetioa 222.1T. Fbrida Statute~. .
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I was iormcrl a kgal cesideat ot ~ I~ vrt 0 Fi ~ ~ i~ ~ S aad I •
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it ~~'Y L dt wnc~~ lt.~ - However. I Aave ebaaged aqr doaaiu'le to
tear.~e..a K~~ ~ •
and am aad bave been a bons fide resideot otlhe State ot Fbrida siaos ~S t? t n f~i ~ ~p ~
19~ aad I reside at 7~ ~ SQ ?dN rIQ S~~n~ Dr. -l .e~. r'eht~
(St~wc.ed Nw.b.d
r f ~i erGt~ _ ST. lUG 1 E ~y,
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and t6ls statement is to be takea a~ npr declaratioa ot eitluaship. aetnd kga! nsidenee and domia'le ia tLe Stste d Flaida.
If POR TNE PURPOSE OP ENRO~IING IP POR HOMESTEA~ PURPOS S~
CHILOREN iN 56HOOL~ PLEASE STATE PLEASE CNECK: -
tHE1R NAMES. .
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- S~~IdCtE COUNTYRPI.A.
ROGER POITIUt ~
' " CLERK CIRCYI~ QOUItT
RECOi1D VERIFIEO
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35Q31•j
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f ~ I FUATHER CERTIFY that I~r~71 register at mr local address wben the ngistration booka nopen. and eomptp with all
j otber requirements oi a legsl resideat ot this State.
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~ 1 CERTiFY tlut I have no inteation to ntura to my tortner domic~e. aad I intend to remain ia
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er;~' ~tr~~ _ ST Luc~E _County.
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~ Fbrida. permaneati~ .
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S~rorn Rad subse ibcd betoro a~e tAI~ __J day ot ~-c~e~. ~ 3 S~- 5-~~
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_$OGER PQ I TRAS„ CLERK OF' G I RCU I T COU2T
"ST. LUC { E COUNTY, f LOR 1,UA ~
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EPUTY LERK
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