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TO TlIE CLERK OF TN6 CIRCUI'C COURT. 4U~~•~S - . : ~
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' ST. LUC t E COUN1'Y. FGORIDA: !
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'rhi~ b mr deciaratiae oI Domicile and CiLjsen~Aip in tl?e State o! florida that I am filing tAis dsy in seeordance, and tn
contorn?ity rvitA Section 22'.17. Florida Statut~s. ~ ~
1 was to~ a Icgsl rosident ot ~~V /p v~ ~ - aad 1
ICitrl IStat~?
rrsided at X~~~~ ~ 1 r f` , However. I hive cAanged my domicile to ~
(Str+~t wd Nwoberl j
•nd am and have been a boaa fide tesident o[ the State of Florida sinee _s.~~~-~-_~ E ~ f~ ~ d~y ot
.19_.L~_~. and I residc st lo [D T/~~ E V-~
' (Stt+et snd NumEs~l
fi t', ~ C.,, ~ ST. LUG 1 E Countr.Florida,
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•r~d this statemedt is to be taken as my declaration of citiunship. actual tegal resideace and damirite in the State o[ Florids.
If iOR irtiE PURPOSE Of ENROLLiNG IF iOR HOHESTEAO PURPOSES~
CHILOREN !N SCHOOL~ PLEASE STATE PLEASE CHECK: ~
THEIR N/I6:ES2
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f~~EO ~MD RECURUEb ~
ST. tUC~E COUNTY F~,~ ~
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4 ~91.85
I FURTItER CF:RTIFY Lhai I will registrr at my local address when the reg"cstration books reopen, and comply witfi aU
otAer requircmcnu oi a.legai resident of this SLatc. -
I FURT}iEZ CF.IZTI~Y that I have no intention to return to my [ormcr domicile, and I intend to remain in
~'T' -~,'~~Qd E- , ST lut 1 E ,Coonty,
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Flcrida, permanenti~.
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(Addresei.
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o: n lo end sub~cri6~~d b.~.orr nic tt?iS day o[ ~1~~i •/._~,~(=4i r~~t, `t 5 ~
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ST. llK ! E G~UN1~Y, F LU.t 1:UA -
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C('U7Y ICRY. ~
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