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TO T}lE: CLERK Or' TlIE CIRCUIT COURT. a~~518
, ST. L UC I E
- COUNTY. FLORIDA: ;
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Thi~ b my decl~ration o~ Domicile and Cit'v.onship in lhe State oI Florida that I am filing this day in ~aord~nco. and in
confo~mity with Scction 7l'r.17~ F1oriJa Statute~. ~
I wu~ tormcrl a lega! resiJcnt o~ y~ 1~ G f' 111/L' L= S ~/L~ ,C7 //q/L I~~Rd I
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resided +tt lv D ~ Sr~ .r1 5,~ N~ow?tver. I lu~ve ehangcd my domicilc to
(Stre~t ~od Num~fl • • '
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and am and heve bcen s bona fidc tesident of the St~te ot Ftorida aince _ ~y o~
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`_..19
7.~ and I reslde ~?t ,L;~ ~ il'I / D~o,~~-
(Stte~t aad Number) `
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, l~ / E~ C~„_, ST• County, F'lorida.
(Ctt~)
and this statement is to be taken u~ my declaeatioa oi eitizen~hip~ actual Mgal re~idence and domicile in the State ot Floridu.
If FOR THE PURPOSE OF ENROILING Ii F'OR 1tOHESTEIID PURPOSES~ ,
CHIIQREN IN SCHOOL~ PLEASE STAtE PLEASE CHECK: ~
THEIR NAMES:
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rt E~K t+~GU~T COURT
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~EC S ~ ~ 12 ~'~7 .
~ 3~3fi518
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I FURTtIF.R CEftTIFY thrt I will register at m~ local address when the registration boaks rcopcn. and comp!y witfi atl ~
othet requirements ot a lcgal resident o[ tt~is Stale. '
I FURTIiF.3 CE:f{TIFY thsl I have ao inttption to rcturn to my fornier dorr,icile. nnd I ioiend to rernain in
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