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TO THE CLERK OF'fllE CIRCUiT COURT.
ST z L UC I E ~pv~'~'y~ FLORIDA:
• This b my declaratton of Domicile and Citizen~hip in the Stato ol Florida that I am filing this dsy in accordance, and in
eoniormity rvith Sectioe 22'.17. Florida Statute~. _
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I was tormerl a lcgal teaident ot ~ and I
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tesided at G~~ ~ ~ Nowever. l Aave eh,?ngtd my domicilc to
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and am and have been a boaa fide resideat of tAe State ot Floc~ida since ~y o~
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,_._..19_L. and I te~ide at ~
(Stre~t ~ed NumDerl
~~p~ ~~~t.~2it.t~ ST. 1_UG 1 E Couoty, Florida.
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and t}~is statement is to be takea as mr declarstioa oi citiuruhip, actual legal residence and domicilc in the State ot Florida.
IF FOR THE PURPOSE OF ENROILiNG iF i'OR IfOMESTEAD PURPOSES~
CHIIOREN IN SCHOOL~ P~EASE STATE P~EASE CHECK; ~
THEIR NANES:
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I FURTHER CERTIFY that I wi7! register at my locat addres~ when the registration books reopen, and comply with all
~ other requirements of a iegal resident of this State.
~ I FURTHEZ CERTIFY that I have no intention to return to my Iormer domicile, and I iatend to remaen in
~ • S T. L u t t E . County,
~ (Cit~l . .
~ Florida, permanenti~ .
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° Sworn to and subzcri d bcforo :ne thu day o[ ~l_,~J ! T
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~ . A.D.19~,
~ ROGER P01 TRAS, Cl_ERK OF C lRCUi T COI~tT
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ST. LUGtE COUNTY, FLOfttUA •
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