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Declaration of Domicile and Citizenshi w~
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TO THE CLERK OF THE CIRCUIT COURT.
ST. lUC I E ~pUNTy, F[,pRIDA:
~ • ThL~ is my decluation ot Domieile and Citizenship ia the State oi ~'lorida that I am C~ag thIs da~r in aceordanee. and ta
( eoatormiey wich Seecion 2z2.17. Ftorida Statutes.
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~ I ~ra~ tor~ a kgal resident o[ ~~L ~ and I
, . n tcur? ~seac.~
~I nstded at •S /C'~ , Hmvever. I have ehang~ed my domicile to
(8wat aod NumbK)
and am and have beea a bona Cde r~.?sident ot the State ot Florida siace ~ day of
, ~ .19~~ and I reside at ~ / ~'~O~'~~`- ~
~l _ /ry (BtrMt ud Numbu)
-~e-~i'" ~P ;t n, t~ ~~C ~ ~ ST. LUC I E County. Florida.
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and this statement is to be taken as my deelaration oi eitiunship. actual legal nsidenee and domicile in the State of Florida.
IP fOR 7HE PURPOSE Of ENROLLING IF FOR HONESTEAO PURPOSES~
CHILDREN~IN SCHOOL~ PIEASE STATE PLEASE CHECK: ~
THEIR NAMES: ~
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ST .h~.,_..
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I FURT1iER CERTIFY that I will register at my locai addreu when the registntion books reopen. and tompty ~vith all _
other requirements of a legal resident of tbi~ State.
I FURT ER CERTIF Y that I have n4 intention to return Eo my former domieile. and I intend to remain ia
~ ' ti~'~ ~ S T. L U C 1 E . County.
(Gt~l .
F'lorida. permanen~i;.
P~o~6~ _ (~els-e,~
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INam~)
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Sworn toy~d subseribed betore me this day of ~ ~ ~ ~%~t c~ ~t t~ ~ < L _
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. A.D.19_L~ ~
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ROG ~ POI TRAS, CLERK OF C IRCUI T GOl~2T 3 3 y s~~
ST. LUCIE COUNTY, FLORIUA •
8Y: ~J
EPUT LERK
800K
~ R 263 ~E 74
AGO Form 7t 22
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