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Declarat~on of dom~c~ie and .C~t~zensh~p , <i
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TO THE CLERK OF THE CIRCUIT COUAT. ! i
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ST. LUC t E ap~y, ~,p~pA;
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1'~b b an~? dee4rat~a o~ Oomteii~ aad Cltur,enship !a tM State ot F7otida tbat I am Gli~ tAis da,~r i~ aooo~dana, awd is' ;
eaalormity with Seetioa 271.17. Florid+~ Statutas. ~
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i11tI iA1 ill~ IIaVO bQQll i b0lla C1~Q I'~3~QAL 0~ Llle S~iu 0~ F~OTItIi l1oM ~r~/ O J~i ~~~!/'9 ~ t~~~ ~ 9 7~ ~
19.,~ and I reiide at f l~;~ t~ M A X v? L~ L C, ~4w/
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" sad tl~b statemeat b to be ttken u n~? dedaratioa ot dtisen~htp. actual kgal resid~nee and danin'le in tbs Stata ot ~'iocida.
If fOR- THE PURPOSE Oi ENROLIING ~F POR HOMESTEAO PURPOSES~
CHII.~REN IN SCHOOI~ P~E/lS~ STATE PtEASE CNECK: ~
THEIR NAMES:
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I FURTHER CEItTIFY that I will-register at my local address when tbe registration booics rcopen. and comgly ~vit6 al{
othtr requiremeats o[ e Mga! resident oi this Sbte.
I FURTNE~ CE~tTIFY that I Aave ao intention to eetnrn to my focmer domia'le. aad 1 intend to cemain in
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Florida. permanenti~ .
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Sworn to ~nd subscribed belore me this ~ day ot 1~0 'T S?'~, _!v
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ROGER PQ.~ TRAS,~ C~ERK OF C IRCUI T COUtT
ST. LUGIE COUNTY, fl UA ~
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EPUYY tERK f~ta
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