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~ TO T11E CLERK OF' THE CIRCUIT COURT. - . ~ . ' ; ~
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~ ST. LUC 1 E ~p~~t~y~ F'L,pRIDA: I
TAis is my dcclar~tion o[ Domicile and Citizen~Aip in the State of FMrida that I am Gling this da~ in ~ccordaAee. and in ~
eontormity with Section 2~Z.1T. E'torida Statutes. ~ ~
I wu fo~ erl a legal re~ident ot r1 ~ ~ n(~ ~ , ~ l~ aAd I
. ICit~l lStat~l
rrsided at U ~ lZ-, lZ. ~ , However. I have cha~ged mr dom?eile to -
(3trht ~?d Number)
and am aod have been a bona fide re~ident ot the State of Florida sinee ~ day of
J~ 19 ' ~ - ~nd I reside ~t ~ ~ fl c~ ~r, ~ ~N ~1 v
lSt~eet and Nam~erl
~j--t ~ u C~ G ~ ST. LUC I E Countr, Florida,
(tSt7)
•nd this statement is to be taken:s my declsration oi citizen'ship, aetual legal te~idence aad domicile in the S4te ot Florida.
If FOR 'ff1E PURPOSE OF ENROLLING IF FOR HOHESTEAD AURPOSES~
CHILDREN IN 5CNOOl~ PLEASE STATE P~EASE CHECK: ~
TNEIR NAMES:
~~LEO AND ~fCV~DEG
ST. ~UClE CO~MT7 F~4
RO~~%' POtT4AS
r -rc. : :U'T ~::~•P,/
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J~JL l 3 06 PM'16
- .~U9~10 ,
1 FURTIIER CERTIFY that t will re~,~ister at my local~ addres~ w•hen the registration books reopen, and comply with all
other requirements o[ a ie~al msident of this State.
I FURTZIE:t CERTIFY that I Da~c no intrntion to return to my fonner doitiicilc. and ; intcnd to remxin in
' ~ 1-. ~ ~ ci ~ $T . U C 1 E . County.
lCit~! .
Florida, pcrmancnti; . ~
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$~ti ~~~-r, tu :ind s!~b~,cr:!~~~d h.•(orc tt~c 21~i, ~ d.ty of ~ y ` - - ~
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ST. LUC I E C4UtdTY, F LO't 1 UA
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