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411304
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~ TO THE C1.ERK OF THE CIAC[JCr COURT. , • - , ;
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' ST. L UC ! E ~pUNTy~ F1,pR1DA: ~
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This is my declantioa ot Danicila ~nd Citluewhip in the St~te ot Fbrida ihat I am filing tA[s day ia aecord~ace, and in
coalormity vv~tA Section 222.17. Fiorida Statutes. .
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I mas [ocm~rlY a kk6aal resideat ot ~Q- • and i
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rrtsided at ~ ~ . However. I t~ave ch~nged my domicile to •
&ewt ~ad Numl~l `v~
and am aad have been boaa fide rcaident o! the S4te of Fbrida =ince ~ G-~~ day ot
19_.,,Z~ aad I reside at .
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' ST. LUC 1 E N~~!
Couaty. Fiocida.
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and tlus statemeat is to be takea as my decLntion o[ citizen'ship. aetual kgal resideace and domia7e id the State ot Florida.
I~ FOR irNE PURPOSE O~ ENROIttNG Ii FOR HOMESTEAD PUR-POSES~
CHILOREN ik SCNOOl.~ PLEASE STAtE PLEASE CHECK: ~
~ " THEIR NANES:
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fIlEO AMD REC:}(iDEC
ST. ~UCIE COUNTr F~R
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I FiJRTIiER CEFiTIFY that 1 vy~l register at my local Address when the registration books reopen, and comply with all
othcr requirements ot a legal resideat ot this Statc.
~ J~URT~IER .RTI hat,I have t?o ini~ntion to return to my former domicile. and I intend to rcmain in _
• , ST . L uc ~ E ~ , County.
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Florida, perman~nti~ .
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S~.•o n lo and sub~crih~-d b~ forc mc this .~Z`_ day of ~ 3~f ,S~
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