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' Dece~r~~~an c~~ D~r~icile and Cifi~~enshi ~
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TO TNE CI.ERK OF THE CIItCU1T COURT.
_ST! LUCI,E~ c:otlrrr~r. r'i.o~uQA: .
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lbta fs tny dectuatton oI Domtcile and Citiun'shlp in the Stat~ o~ Fbcida ti~at I a~ filing Lhb dy? Ia aeeocd~nce. snd i~t
eoatormity aieR SettioA 2~.t7, Florids Statutes.
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I wra torm~ri ~ k~al t~sident ot . ' ~ I
' ~o% ~l yd • 2`~`'w~.~' ~s~ -
n~~ ~t However. I luve changed my domic~e to
lStr~d and PlumDa) ~ ~
•ad am and have bee~ a aona fide resident ot th~ State ot Flatida since dar ot
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19~, aed I restds at ,~~',.~2 - 9~~^~`*'r" ~~'~-d p~'~L '
ISw.t a~d N~mbed
- ST. LUC ~ E Countr, Florids.
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' and this statemcat ia to be taken as mr d~eclaratioa ot titIua~hip. aetual bgd residcnee and domitile ia ti~e Stato ai Florida.
IF iOR THE PURPOSE OF ENROl.L ING - Ii i'OR HONESTEIID PURPOSES~
Cltl ~DREN 1 N SCHOC;.~ PLEAS~ STAI'E PLE/tS[ CNEtKt ~
THEIR NAME5:
~Q ANO REC~R~E4.
- 11CIECOUM Yat~
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I FURTHER CERTIFY that I w~71 re~ister at my local addres~ when the registralion boolcs reopen. and eompty with ~11
other t~quirements of a legal tesident ot this State. - -
I FURTIiEZ CERTIFY t??:t I hav~ no inttntion to nturn to my former domicile. and I inicnd to rcmain in
ST. LUL 1 E ~~ty~
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F'lorida, permaaenu;. ,
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Sworn to and subseribed bcfore mc thi~ ,,,~f~ dar ot '
_ , ~E' M A.D.19,.7~7 -
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ROGER P41 TitAS, CIERK OF C IRCUI T COl~2T
SY. LllG I E COUNTY, F t_O~t 1 UA • `
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PUTY IERK
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