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TO THE CG~ItK OF T~IE CIRCJIT COURT, s
~ ST. L UC 1 E {~UNTY. F~.ORIDA:
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Thi~ ts tny dcclaration ot I3omicJe and Citizon~hip in lhe Stato oI Fb~ids that I ~?m filing thu day in aecordanco. a~d in E'
conformity with Section 2~:.17. Ftorida Statutcs. j:
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I aas tornnc~ a kga
l resi dent o t ,
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~ ~ Or~QF~/ ' F~L ~ . Nowever. I h~?ve cfi~?ngcd my do:nieile b
resided at .
, , ~8ur~t and NumMr1
~nd am and have beea a bona Gde reside.~?t oi the Statc ot~Florid~ ~ince ~ ~ day oi
z q~ 12oL_._f~ ~J~~~d ~ ~
R'~._,_,..191 and I reside at
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~v~ f%. ~ Ul / F ST . lUC 1 E Couoty. Florida, .
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and this statement Ls to De taken u my doclaration ot citizen~hip. actual kgal residence aad domicile in the Stste ot Florids. ~
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IF FOR THE PURPOSE Of ENROLLING IF fOR HpltESTEA~ PURPOSES~
CHILOREN IN SCHOOtt PLEASE STATE PLEASE CHEGK: ' XJ
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tHE iR NAMES: ~ ~~r
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; I FURTHER CERTIFY that I will rPgister at my local address when the re~isiration books rcopen. and comply K•ith all '
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othci requirements ot a legal resident oi this Statc. - `
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I FU }.:t CERTIFY t~ I}~ave ao intcntion to return to my tormer domicile. and I intend to remain in `
` C~- ST . L U~ 1 E . County.
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