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Declaration of DomicilQ and Citiz~~ship ~
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TO THE CLEItK OF TlIE CIRCVIT COURT. .
ST. LUG 1 E ootltv~t~. F[.OtttD~: .
Tbb b nq? daiacatton o~ Domictie aAd Citisewhjp in tbe State ot F1orlda tbs! I am filiaa thb da~r ta aeeoedanee. and ta
eootoraaltr witb Sectioa 2?2.17. Florida S
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I~ra t rmer a kgal raaideat d ~ ~9bd I ~
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eesided a! .u - Howerer. I Dsve ehanged aqr daaiu7e to
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aad am and ba~e been a boaa tide resideat ot tbe State otFlorids sina da~r ot ~
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ST. IIIG 1 E ~o„pcy. ~or;a,,
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aad tlds statement is to be taken as aqr dedarattoo ot citiuruhtp. tetnal kgal e+esid~ace and domidle In ths State oi Florida
If POR.THE PURPOSE OF ENROLLING IF fOR HOMES7EA0 PURPOSESi
CM 11.OREN 1 N SCHOOI~ PLEAS,E STA7E ~ P1.E/lSE CHECK: ~
THEIR NAMES. .
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II ~~~%C%ifQ/l~.L~.~ ~J~Li~~~l~ ~~~ANO AECOROEO
f . IE COItMTS'.ftA.
• J ~ER POfTRAS
ttEltK CIRCUIt COURT ~t ~
Rti~RO rE11~f~E~
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i I FUItTHER CERTIFif that I w~71 register at mr lo¢al addres~ rvben tb~ registratan books reopen. ~od eompip w~itb aU
~ otAer requlrements ot a legal resident ot this State.
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~ I F'UI,~lfIE~ ;E$TIF'Y thsbI 6av£ ao Iateation b ntnrn to ~n~r i°~UC I~e. and I iatend to remain in
./:.i~ ~ r1~ ~i~.~l~ _ - ST - . County.
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; Fbrida. permanenti;.
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~ Sworn to and subusibed bctore me this ~ day ot ~ 3~~y
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A.D.19~ 7 _
R P AS CL RK Of
C IRCUI T COU2T
E ST. LUCIE COUNTY, fLORtUA • -
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, EPU LERK
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