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TO THE CLEnK OF TfIE CIRCUIT COUItT. ~ ~~~VI~r
ST. LUC 1 E~~+apV~y~ FLORIDA:
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'1'hV u rr~r dcelaratioa ot Aomlcila aad Citizensblp ln t!?e State ot F{cridu that I am filing this dyr ia aawrdance, and in
eonforniitr with Settion 222.1T. Fbtid~t Statuta~,
I rv~?s te~ a legal resid~nt ot _!~f/PS ~ C1tPl~~/e ~ ~ I P.t/~t~//¢- And I .
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nsided at 1_Q ~ S~t~ ( y,,,~ w/dt. ~~-L tJ ic- Ho~rovo~. I have cAanged my dom~cilo to
i9tn~t ~ed NumO~N , •
•nd am aad have bcoa a bona Cde resident o[ tho State oi Florida ainte day of
(1l ~~f'~~ 19~2.. and I reside at ~Q,,
_~2-1~~/51- • ,~~-T ~LPS ~,~y,/ Q~ '
~wl_S~n1 ~i2 ~ ~ ST. lUC I Esc~a.oatv~~~ ~
Couatr. Florids.
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" aad this st~tem~nt is to ba taken a~ tny dahcation oi dttzecuhip. actual kgal res~den~
and domicile In the Stato ot Florida. t
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f~ fOR THE PURPOSE OP ENROttING IF FOR HOMES7EAD PURPOStS~ ~ i
CHtt~~REN {N SttfOOL~ PtEASF STJ11`E PLEASE CHECKS ~
YHEIR NAMES: ~
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1 FURTHER CEFTIFY that 1 will register at my local addreu wbea the tegistration books reopea. and comply with all
othet requiremenb ot a legal resident of this State. - _ ~
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i F xea CE¢TI~Y jhat I hav~ no Intention to return to mr former domicik. a~d I iatcnd to remai~ in
~v~..~ca~/ ~'3l''/y[J ~ ST. t.UC 1 E Cour.ty.
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Florida. permanenti; . -
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Sv?orn to and subscribed bcioto mu tfiie r.~ day ot O~ ~O '2 ~/r %
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ROGER PO ~,RAS. CLEZK OF G IRCUf T COI~ZT `~3~-~7
ST LUGIE COUN Y ~
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