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' Decl~ration of Dorriicile and Gitizenship
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T01'~IE CI.ERK OF THE CIRCUIT COURT. ' . ~
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Tl~t~ b my declustlon ot Domieile and Cltlsatahip ia the Stat~ oi Fbrida tAat I am tdins thts dyr ta actordaac^~. and iet
eoatorn~fW? w?Itb Seetioa 222.IT. Florid~ Statut~s.
I~?at to~ s lesal resideat ot ~~•t.J ~ I QR E l1
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lGtyl fstat~I
t~tsided at f~[f2 / M~ N~ ~ /Qf~. . . Ao~we~er. I Aave el~ngrd en,p doeeeic~c to
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aad un aad bava beea a boaa Gde nsideot otti?e State al Flo~da siace ~ da~r ot
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($N'Mt a~d Nrmb~rl
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1 5 i -Guc r E , ST. LUC i E ~„ocy.
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~ aad thIs statement is to be takea as nq? de¢lar:tion ot eitisenship. ~ctud kgal resideQee and domie~e in the State of Florida.
IP FOR THE PURPOSE OF' ENROtLING If FOR HOMEStEAC PURPOSES~
tHtt~REN IN SCHOOl~ PIEASE STATE PLEASE CHECKS ~
TNEIR NAMES:
ST~ P~IF~ I?'? . UoT~~v.s,Z~ , .
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I FURTHER CEItTIFY that I w~71 register at my 1oci1 address when the registtalion hooks nopea, ~nd comply with all
ot6er requirements ot a legal resideat o[ this State. ~
FURTNEZ CEATIFY tlut t h~ve no intention to retnrn to m tormer domicile. aad I intend to remaia ia
o R"T • sT c.c, c~~ , ~r . L uc ~ e - Councy.
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Florida. petmanen~i~.
ST.IYCIE COltNTY fL4.
~ ROCER r011RAS
CtERK ~iRCU1T COURT
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RpGER POJ TRAS_,,,_CIERK OF G IRCU 1 T~t~2,'~v~
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