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TO THE CLERK OF TtiE CIRCUIT COURT~
ST. l UG 1 E - ~p~~y. ~,p~p~; ~
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Thb b mr deelaeatloa o~ Domicile u~d Citi:en~hip ia the State of F'Ioclda that I am 61ia~ t~?is da~r in secordancs, ud in
confor~aity witA Seetioa 2Z2.17. Florida Statute~.
I wa~ lo~~ a kaal reaideat o~ ~1 F L.L ~ tad I
, tckr~ ~ ~e~
~e~ a~ ~j~' dt ~/A LL t- Y e~ R - Ha~wr. I ha~e chaa my domicile b
IHtr~~t ~nd NumbK1 • /
and am u+d hsve beea a bona Gde resideat ot thc State ot Fiotida since ~ U~-~ ` d+~y ot
=T L i l~~ ~ I r~~~ l~ 3 ~ ~ ~ E. ~ ~LtL+ ~ ---`7'El~ .
~8trMta~d Nom~r)
~o Q'r ST. L r~ ci E ST. LUG i E ~„ocr. ~;d,,
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" aad this statement is to be taken as mr declaration oi eitir,enahip. actu~l kgat reaidenee and domieile In the Stato ot F'brida.
IP FOR THE PURPOSE OF ENROLLING Ii fOR NOMESTEAO PURPOSESi
CNIIOREt~ IN SCHOOLi PIEASE STATE PLE/lSE CHECK: ~
THEIR NAMES:
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U61CIE CO~tiNTY FIA.
ROCER POITRAS
- r.! ~RK cIRCUIT COURT
' " " vf 'tIFlEO
~ ~ ~ ~Jui IS 3 03 PM'71
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I FURTHER CERTIFY that I w?11 register at my loca! additiss ~?hen the ngistration books reopen. snd eomplr writh all
f
other requirement~ ot a legal resident ot this State.
; I FURTNBZ CERTIFY that I hAVe ao intrntion to retura W my Iormer do~aieile. aad I intend to remain ia
~aRT' S~T', L. Ucj~ , ST. LUCIE ,~Qty.
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~ SMara to ~nd subseribed bctore mo thi~ day o[ ~O R'T Sl7~:~~G/~ ~L-A , E
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~ ROG~,R IZR S. CICRK OF C~I RCU i T COURT ,
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~ ST. LUGIE GOUNTY, FLURtUA ~
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EPUTY LE
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