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Decl~ration o~ Domicile and Citizenshi ~
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TO TNE CGE1tK OF THE CIRCUI'P OOURT. i
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ST. L UC 1 E ap~~. ~,p~~;
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a Th1s is mr deelarseiou ot Doaaku. aod Ciets.nsh~p i~ ~h. S~.c. ot F~oe3da cbac i am cu~ eh~s d.p ta aeeocaaae.~ afld ~t! `
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oopto~,u~ity w~t~ Seetion 22Z.17. Flo~ida Seatue.s. i
I w~s t~ a leasl e~eaideat ot _~1 ~-w A~\~ T. ~e~d I
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t~esid~d ~t ~-10l NT~ ~ p,~„ ~ Z 1 - Nwwv~r. I luve ebangrd m~p domicile to
1~~ ~ Na~sewl ~
aod ana and luv~ baea a boaa Gde seaid~nt ot the Stat~ ot Ftosid~ ainee ~7 ~
PR~ cz l -.19,..~.. aad I e~esid~ a~ ~ 1 k~ V~, t`C 1~R•, ~ N C T.
(StMt nd N~mMH _ -
,~C~Z'~ 1„~ c.: - _ ST. LUC t E Couatr. F'Ioctea.
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" snd tbls statemeat is to bs taken u wr decLratioa oi eit~easl+ip. actua! kgal ce~ideeoe and doatia7e the 3tate ot Florida.
~i i0R THE rURPOSE Of ENROLLING If i0R HOMESYEAO PURPOSES~
CMIlGREN IN SCNOOL~ PLEASE STATE ~ ~LEASE CHEGK: ~
TMEIR NAMES:
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I F'URTHEB CERTIFY thst I w~l register at mr local addns~ ~?hcn the registrstion books reopeo. and eompty .vich all
otber requiremeats o[ s legal rtsident oi this State.
I~~`URT~IEZ CEBTIFY that I have no iateation to return to mr former domicele. aad I intend to temain in
o~-c ~T 1,~~c.: ~ ST . L u c ~ e , County.
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Sr~ora to and subscribed bc[oce me thls U dsr ot ~ ~Qst l` ,,,,5~',_,_~~ c,~~ ,~.~i„~
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fILEO AMO RECORp;Q
~-I7 . A.D. ~9~ ST LUCiE COUNTIr F~A.
RO~~{~ PQtTRAS ~
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ROGER PO{ TRAS. GLERK OF C IRCUI T COI~2T -
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ST. LUG i E COUNTY, Fl.Oft t.UA • ~a~ ~ ~O ZO QH'T$ .
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