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TO TlIE CLERK OF THE CIRCUIT COURT.
ST. LUC I E ~pU~y. ~~IDA:
• ThL~ Is my declaration of Domicile aad Citisenship t~ the Stals ot Flotiria that I~m Ciling tAia day in sccocdance. ~nd In
eontormity with Section 2~.17, Ftorida Statute~.
I ~ru former~y a legal re~ident ot ~ r~ ~ 1~ F' , ~ k' / e - and I
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residcd at ~~r c' ~ ~ f', Howevec.l6ave changed mr domicilc to ~
(Ser~K ~nd 1YumD~~i ~
and am and have bcen a bona fide resident of the State ot Fbrida sinee day of
_~J F t7 ~ .19.1~. and I eeside at ,l ~.S N.v c~t /y v. ~
, c ~ ~ lStr..e ~nd Numberl
t'T . J n, N ~ ST. LUC I E Couoty, Florida.
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and t6is statemeat is to be taken e~ my declaration ot citiunship. actual legal reaidence aad domicile in the State oi Florida.
If iOR 7HE PURPOSE OF ENROLLING I~ POR NOl1ESTEAD PURPOSES~
CHI LOREN I N SCHOOL~ PLEASE STATE PLEASE ttiEtKt
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T N E i R N A IN E S:
' • FIIE~ AMO RECOR;,t ~
ST. «C!E CpUN1Y F~ ~
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' I FURTHER CERTIFY that I w~l registe~ at my locai address when the registration book~ reopen. and comply with a;l
~ other requiremeats of a Icgal rrsident of this State. .
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RTH~:Z CERTIFY thst I have no ir,tention to return to my former do~icile, and I intend to remain ia
~~~•-~'f ~ ~ ST LUC 1 E
- ~ . County.
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" Florida. permanenci; .
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Sworn to nnd suDscribed bctore me t!~~is ~ day ot
_ ~ ~ . - . - , A.D. 19~, .
_i R06ER P01 TRAS CL ftK OF C IP,CUI T COt~2T
'`F ST. LUC 1 E COUNTY, F LOR 1 UA ~
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~s EPUTY LERK ~
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