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Declaration of DamicilQ and Citiz~nship
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ST. lllC I E apvt~r~r. ~t,,pRme:
deelaraUon ot Daaie~e aad ptincn~Ai in tM State ol ~'IorWa tbd 1 am Glias tbis dyr iu aooo~dana. and ia ~
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~oe6ocmity ~rtth Seetfoa 222.17. I~'locids SLatuta. • -
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i~ras t nncrl • tegal re~ident o[ 1 1 ~t 1~~~' ~7 rZ.i G
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es~id.d st _3 ~ J~ ~ i s JR~ v 4 ~.~c - Ho+~wer, t ha~. cbsaaed w do~k~e to
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aad am sad ba~e beeo s boaa tjde resident ot tl~e 3t~te ot Flocida daoe 1
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sad this ststemeat is to be takea a aqr deelsratio~ ot dUuaship. actwl kgal nsWenca and doaatci{e jn the Seate oI Fiocida.
If I~OR TNE PURPOSE Oi .fNROLLING If fOR HOMESTEAO PURPOSE
CHtLOREN IN SCHOOL~ PLEASE S?ATE ?~E/lSE CHECK:
tNE1R NANESS
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- ELERK CIpCl11T COURt
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f I FUR7'~iER CEATIF7f thst-I ~1 register at a~r ioeal addres~ ~rlkn the ngistcation books nopen. and compb w~iih a!1 - -
~ othcr rcquireaunts ot a kga! resident of tbis State.
I FURTH~i CERTIFY that I have no iatention to return to m fo~ane~ domici'k. and I lutead to rem~in ia
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Sworn to aad subsc~ibed betoro ene thb ~ dar o! i~/'?~ ~~~!r 7
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ROGE PO1 TRAS, CIERK OF C IRCU{ T COU2T .
ST. LUCIE COUNTY, fLORtoA ~ .
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