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ST. LUC 1 f _COUN'I7'. FI.OItIDA: ~
This 1~ my c1c•clsrrtion o~ 1)n~r~ici!r anJ Citi:cnship in the Stnto oI Floridn that I am filing thb dAy in acco~dancc, ~nd in
conformity with Sectiun :"L.''.17, FtoridA Stslutc~.
I wa f~rmrrlZ s Ir aI residcnt of ~ ~ser/ .
8 and I
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resided al - ' However. I h'e ehanged mr dornicilc to
(5tnel and Numb r)
•nd ar,~ and bavc 6ccn n bu~a fidc residcnt oi the Statr o! Florida ~inco _ y
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19~ and I reside et ~.~..~~~~_s~ ~GL-~
p u-c-2-
" (Stre~t aad NumDer)
' ST. I.UC 1 E
County. Flurida.
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nr.d lhi~ stalement is ta t?c tsken ~a my decl4r~tion e[ ci~izen~hip, ectual lcgel re~icicnee end domicile in the Stste ot Florida.
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IF fOP. TF~E PURPOSE pf
Et1ROLLlNG IF fOR HOM~STEAO pURPC~SES~ ;
CHII.DP,E11 1!~ SCNOOL~ PI.EASE STAT~ PIEASC CHEC1:: ~ i
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I FUf:T~I£R CER1I1'Y th~t I wif! re~isi~r Pt r..~• locnl acidress H•hen thc rr~istratioa La~ks reopen, ar.r; co:aply witl~ n~l
ntt:er mruir-^taen:s u( ~ 1^~;.~; rt:eden[ cf t~is .`'i:ate.
I I~ UF•Tt ':Z C"I:Ti 'Y th~t I havc r.o inten:ion i~ ~rturn !o ray tcr.ncr oo:nic:le. end I iutci~d to rcr..~in :r.
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