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TO TIIE CLERK OF TIiE CIRCUIT COURT.
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ST. lUG I E CpUN7'~f. F'I,ORIDA: _ ~
• This Is my decisration of Domicile and Citizon~hip ia the State of Flotid~ lhat 1 am t~ling t1?is dap in ~ccordanco. and In !
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eontotmity with Section 22..'.17. Florida Statute~. ~ . .
I~ras torm~ri a kgal residcnt ot _s51Do~ A L F L Na i S aed I ~
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resided at N~ ~ L/~~~i91 E~d . HoMever. I bavs cbanged my domicile to
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•nd ari? and hsve been a bona Gde resident o[ the State of Flotida siace day ot
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S~~~eA PE -1~~, ~
19l and 1 reside aL ~
IStn~t ~sd MumDed .
~T', i~.r~c~ ST. LUG I E County. Florida. ,
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and this statement is to be taken u my deelaration of eitizen~hip. actuel legal re~idence aad domicile in the St~tc ot Florida. ~
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IF fOR THE PURPOSE OF ENROLIiNG IP FOR ItOMESTEAO PURPOSES~
CHII~REN IN SCNOOL~ PLEASE STATE PLEASE CNECKI ~y ~
THE I R NI1ME5: ~
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i I FURTIIER CERTtE'Y that I will register at my local address when the registratioa books reopen. and complr with all }
~ othcr requircments o[ a legal residcnt of this Stalc.
~ 1 FURTfiE:t CER1'IFY th~t I have no intenteon to return to my forn~er domicile. and 1 intend to remain in `
E ' FT• P%ERC.E , ST . L UC I E , G,unty, '
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Ftorida. permanenii~~. ~
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~ 5wof ri !o anJ sul~scrii~cibctore n~e t~?is ~ day ot y~G(
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