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~ Dectaration of IDomici~e and Ci~~ze~ship
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ST. LUC t E ~ apurrry. FLpRIDA: ~ `
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• '_!~s t~nx ~1,?r,t~on ot nomicile aad c~uaeaship tn cb. sesc. ot Flotds wt ~ aw ~lia?s t~s da,~? ia .e~oo~a.noe. snd ia
~onfocmity rvitb Scction 222.1~. Fbrida Statutea.
Iwas tarmeri,~ a kgal r+esjdent ot ~E~TER /N ~ ' . ON~ O ~
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restded at Zd 7$ ~A/?~LET 1`~. ~Q / V~ _ gd,rew:, I tiaw el~aaaed aqr domie~k to
1str..t..a NwDer? . T~
and am aad b~ve been ~ boaa Cde resident ot tbe State ot Florida since 1"~ E dar ot ~
~E~EM 3E~ ~-~9~~ anatra~eac ~yy/ S E. ~ERNA~2~o TERR{1C~ ~
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and th~s statemen: is to be tsket~ as my deelaratio4 ot atheaal~p. adual kgal nsidenee and doa~ia7s ia t6s SLate ot Flaida. i
If fOR THE PURPOSE Of ENRO« ING If POR HONESTEAC PURP ES~
CHILOREN IN SCHOOL~ PLEASE STATE _PLEA~E GHECKS ~
THEIR NAMESS
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I FUR1'HER CEBTIFY tbst I Mn71 reaisier at m~ bcat addres~ wben tht r~gistntiat boalcs nopea. and eomply w?iih sll
otber rcquiremeats of a legal raideat o! tbis State. f
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I FURTHE,Z CERTIFY thst I have rw intention to rtturn to mp former domicik. aad 1 intend to remain in ~
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Florida. pernunena;. :
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Sworn to aad ~ubserlbed betoro me this _L~ day ot Pa~T .S`r L v G~F F~ O~ 33`~SL- - ;
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e- E-- - . A.D. ]9 7 ~ -
.ROGER P01 IRAS. CIERK OF C IRCUI T COU2T
--sT. ~uc ~ E couNnr, F~oR ~,oa `
BY: ~
EPU LERK ~Q~t~ ~
• ~57'.
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