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Deciaratio~ of ~amicil~ and Citiz~~ship
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TO THE CLE1tK OF THE CIRCUIT COUAT.
ST. L uC 1 E courrr~r. ~.ontn~: - .
Thu is my dcclaratlon of Domicile and CitizcmAip tn the 5tato o~ Fbrida that I~m GUng thu dey tn aecordance, aad in
contocadty with Sectioa 222.17. Florida Statutei.
I ~ru lormc~l • kga! te~ident ot " ~ ^~ro ~ , ~ ~ O ~ I ~
t~r1 Iswd
re:ided at ~g G V E R[JA R~ R D, N, ~1 _ However. i Uave cbanged my domic~e co -
l8t:wt sod Nuase.rl •
aAd a~a and h~ve beea a boaa fide resideat oithc State ot Florida sinee ~ cT o Q~~, ,r~ dar ~
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S .19_~~._. atld I resede at G). D!h ~ a~ ll I~ 6E iP?; a-.C o T 7
lSuwt aed Nwoesr)
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iDd ~S t1~~~Q1lR~ ~.1 t0 b! W[CR tS IUy dltliiiU011 O~ GIIZlt41A~P. aetud kgal residcnee atid domicile ia ihe State of F'lorida.
IF fOR THE PURPOSE Of ENROILING I~ FOR NONESTEJIO PURPOSES~
CHIIOREN IN SCHOOL~ PLEASE STATE PLEASE CHECKS ~
THEIR NAMESS
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CLERK C~RCU{t 40U~
11ECOR0 tiEA~fiEOs~"~
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1 FUR7'HER CERTIE'Y that I wiq ngister at my local addres~ when the registration books reopen. and eomplr with aU
other requirements of a legal resident ot thu State. i
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~ I FURTHEZ CERTIFY tlut I have ao intention to return to my former domieile, and I intend to remain in ~
' c~ Er/SF~/ ~En~1f ST. LUC 1 E ,Couoty.
; t(at~) .
ff Flotida. permanea~i~ .
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# Swoto t!? a~? me thia day of . q.+~f r~~. A 3 3~S7
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; ROGER P01 TRAS,~ CLERK OF G IRCUI T COU2T
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! e Y L C R K - a00N 2~~ FACf 73z i
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