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TO Tll~ CI.~RK OF Tl l~ CIRCUIT COUItT, 36i3865
ST. LUC 1 E Cput~'I'y~ E'i.pRiDA:
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9'hb 1~ tnr deelaration of Domteila ~nd Citizonahip in tho State ot F1o~ida that I~m Gting lhi~ d~y in ~ceordsnca, and (n •
eo~~ornnity with Scttion ~~.17, Florid~ Stetute~.
~ I was (ormerl ~ kgal rc~idc~t ot . ~ and I
t t~!
restded at~d6 ~ ~ 7~ However. I hive changed mr domicile to
lStn~t and Numb~H
sad ~m and ~ave beea a bona Gde rcaident ot thc SEats oi Florida eiacs ~ dar ot
19~ and I reatde at 3~
~ . lStt+~t aod Number) -
ST. LUC 1 E Co~acr. ~oriae,
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and thi~ statement is to be taken as my deelaration oI citizen~hip. actuai legal re~idence and domicile in tho State ot Floride.
I~ F'OR THE PURPOSE OF ENROLLING IF fOR HOHESTEAD PURPOSES~
CHILOREN IN SCf1001~ PLEASE STATE P~EASE CHECKS ~
tNE NAMES:
l
' Rt
~~ER~ o~aa~n cou
~~r~~•;;r~a~F~ o
Anr 11 41z PN'11
36386~
I FURTIIF.li CERTJFY that I will regiSter at my local nddres~ when the registration t?ooks reopen. and compty with all
othcr rcquirc~ncnts oi a ic~al resident oE this Ststc. •
~ I FURT;iE:i I IF~I~at -I hevc no intrntion to rciurn to my former domicile. and I intend to rcrosin in
~/~liLt.~~ ~ ST . l_ U C 1 C ~ County.
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Florida. pcrmanenti~ .
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Sw•orn lo end suhscribed bctoro ma thi~ day o(
~ , ~ A.D. l~J~r .
RQC,ER f'OI~R/1S CI~I:RIC QF C IRCUI7 CUUf~T
ST. Ll1G I~ COUNTY, F l_OR 1.vA ~
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ci~ur .~caK
, ~ a0~ 26~ PACE ' ~8
n'.;~1 I ~e 'It .
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