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TO TIIE CGERK OF 711~ C1RCUIT COUItT. •
ST. LUC I E ~pUNTY, Ft,ORIDA:
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Thla Is my ~decleration of Domtcilc ~nd Citaen~hip t~ tho St~to o[ Florid~ th~?t I~m Cting thi~ dar in accordaace. and In •
tontormity with Scction 2~.1T. FloridR Stetute~.
~ I wa tormerl ~ le~al rcaident ot ~d ~ ~ h ~ ~ ' - and I '
l y1 ISat~1
resldcd at ~ r. ~~~7,.~ ~ k~ o/~ - Nowever. I have chan~ed my domicile to
, lStr~~t u~d N me.~l
u~d am ~nd have be~en i bona tide sesidcnt ot the State ot Florids ~ince dar ot
19~ and I re~tde at //1f ~l~~n-w ~,lE 't ~
/ ,~A tifel.le~It ~iP. A f /d y
(SerNt un?~tl
~"1~ . ~if .P[f _ _ ST. LUC 1 E ' Countr, Florida,
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~ aad this statement b to be taken as my declaratioa o[ citizen~hip. actuAl legal re~idence aad domicile in the St~to oi Ftocida.
If FOR THE PURPOSE Oi' ENROLIING ~f' f'OR HOMES7EA~ PURPOSES~
CHII~REN IN SCNOOL~ PLEASE STATE PLEASE CHECK: ~
THEIR NANES:
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A~i A.
~+cr,~~ COUAT
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I FURTIiER CERTIFY tt~at I will register at my locnt eddres~ when the rcgistration books reopcn. and comply with nll
' otl~er requircmcnts of a Icgal resident o[ this State.
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I FUR ItF.Z CERTIFY thst I h~+ve no intention to return to my tormer domitile. ~?nd I intcnd to remsin in
~ ~ E.f'C,f ~ ST . • 1_ UC 1 E _ County.
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Flozida, permanenii~ .
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(Name)
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Sw~orn to nnd suhscribcd bctoro mo this dny oI ~ l~f ~ E.~ Cf fL,~ ~.33 y s a
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~ rta~.~R r~otLns, c~t:aic or c i~cui r cot~ir
ST. LUG i E COUNTY, FLOR i.UA • ~ ' _
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