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TO THE CI.EItK OF THE CIRCUIT COUItT, - ?
STs L UC I E, (~pV~y, FLORIDAt • ~
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eonfocmity rrith Sectioe 222.1T, F'lorid~ Statutes.
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I wrs,t to~merl a kgsl resFdent o! ~ I~~ ~ , and I .
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rsalded at V~' ~ . Ho~rever. I b~?ve ehanged nqr domieile to
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and ~m aad have been boea Cde resideat ot the State oI Ftorida siace day ot
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~ ......:19~ aad I ceside a~ ~ ~ ~ ~ . •SO~ ~ Q~}' 1 ~ Q,.
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_ ~c7 2fi ST~
,_,L~ , ST. lUG 1 E County, Flortda.
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" aad tl~is statement ts to be taker? a+ mr declaratIon of eitlsen~hip, ~ctusl kgd reaidence and domic~e in the Stato oi Flo~ida. ~
IP i0R THE PURPOSE OP ENROI IN6 IF' fOR H N ~
1. 0 ESTEAD PURPOSES~ , ~
~.~iiLORLN ~ t~! SL!lOQt~ Pl.~ASE STATE ~ P~EIISE CHECK: ~ ;
THEIR NAMESZ • ;
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R CER POItAAS
- ' - ~~ERR CIRCUIT COURT `
• 'rr;n Y~;?F~EB
A~c 15 I 46 PM ~~7
- ~ 3~~498 .
I E'UItTHER CERTIFY that I w~! register at mr local addresa when the registration books reopen, and eomply with aU
other rcquirertceats ot a legal resident of thia State. ~
J FU~ E;t CERTIF that I have ao • intrntion to return to my tormer domicile. aad I intend to remain ia •
'T ~'l 12~,"t"~.i~ . L~,~ r_,~ P ~ ST . L U C t E County.
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Florida. permanenti; . ,
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Sworn to a ubscr'bed bc(orc me tAi~ °Z° "dar of D ~ '
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A.D. l9~ ~ 3
R GER PO! AS CLERK OF CIRCUIT~COU2T ~
ST. LUGIE COUNTY, fl.OR1UA • ;
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EPUTY LERK
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