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~ TO T~iE CLBRK OF T`HE CIRCUIT COURT, . ' , ' :
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S7_ LUC 1 E CoUN'i"Y. FIARIUA: ~
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Thia b my declarstion oi Domicile artd Citiseaabip in tM Stste ot Fiwid~ tlut I am C~tiag tAis da~ ia accordanee. and in S
rwiformitr rvith Seetion 222.17. FM~ida Statutes. ' '
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I~ras t~ er~X s legal resident o! ~,~co~i~5 . et r:/ ~„d/~' u~ . r~i~ aad I t
° ICit~) lStat~) ~ `
cesided at ~ m~~~ . Ho~rrve~. I have ehanged my dortucile to ~
tStn~t a~d NumDerl
and am ar~d Aavc been a bot~s fide resident ot tAo State oi Florida einee ~S<
<a da~ ot
~ 19 ~l and I reside at j ~ c G
• ~ ~ad Numb~rl
~~~7~ u L i Q. _ ST . L I E - Ca,nty. Florid•,
. (Cit71
and this statement is to be Wcea as my dcelantion o( citizen'ship. actuallesal re~ideaee ind domicile in the State ot Flotida.
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IF iOR ?~HE PURpOSE O~ ENROi.ttNG IF FOR NOHESTEA~ PURPOSES~
CHILQREN IN SCHOOL~ PLEASE STATE PIEASE CNECK: ~
THEIR NAME52
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~ ' r ~ ~ - /ILEO ANO IIECO~UEL
:T. WCtE COUNTr F~n
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1 FURTNER CERTIFY that I will register at my locai address when the registratioa boolcs reopen. sad comply with al;
other requiremcnts ot a legsl cesident of this $tate.
I F~
TIIER CFRTIFY thst I have no intEntion to return to my formcr domicile. and I intend to remain in
Yc~ r"~~~ ~~C~ e- ~ ST . L U C I E . County.
ICitJI .
Florida. permanen~i;.
~euar,
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Sa•o?n to end subscribrd bc•Iut~ r~u• lhis day oi
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RnGER F'nl 1~2AS, CLCRK Of~_C If:C.lt~ T COURT
ST. LIJG I E COUNTY, FLO~'~ i UA ~
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