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?0 TIIE CLEIiK 0~ TEfE CIRCUIT COURT, ~
ST. LIJC I E ~
COUNTY. FI.ORIDA:
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Th~s Is my deelaration o! Domicile and Cilixenahip in the Sute oI Florida th~t 1 atn fJing this day in actordanee, snrl in
eoafo~mity with Section 222.1T. Ftorida Statute~.
I aas tormerl a legal nsident oI ~~5~ Ct5 Y' , ew snd I
Ipty1 l3tu~) i
testded at SJ 0~ e~V/~~G . Howr~ver. I have changed mr domicilc to
(9trwt aed Nuob~tl
and am and h~ve been a aoas fide resident ot the State oi Fiorida aince ~ day ot
~21~ ~ ,19 '1~~' . tad I reside al O 7' ~I e ~ ~i lIe
~f' Per. c ~ ~sc~.Aax~~~
f ST.. LUC I E Countr. Florids.
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and this st~+t~ment is to De talcen as m~ deelarstion ot citizen~hip. actual legal re~idence snd domicile in the Stat~ oi Florida.
I~ FOR 7HE PURP~SE Of ENROILiNG IF fOR HONESTEAD PURPOSES~
CH t L~REN 1 N SCFtOOL~ PLEASE S1'ATE . P~EASE CHECK2 ~
THEIR NAMES:
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OE~ Zl I I n~ AN'17
3~38604
j I FtiRTHER CERTIFY that I w~7! resister ai my locat address when the tegistratioa baok~ reo~en, and comply R•:ih a!!
other require~aenis o[ a legal resident o[ this Stair.
I FURT~iE:t CERTIFY tA~t. I have no inteation to return to my fora:er dor.si~cile, and I intend to rcmain in
' $ T. L U C f E , County.
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Fiorida. percr.anenti~ .
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