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~ TO'TftE CLEBK OF THE CIRCUIT COURT. . 41~3"7'~ ~
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TAia is my deelaratioa ot Danicik and Cit~eaablp In the Stat~ oI Florida tbat I ata Gling tbia d~t~ in sccordaace. and in. ,
eoatormity rv~th Sectioa 222.1~~ Florida Stat • f
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I ~?as t~~ a kaal rasideat ot ~ ~ j
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resided at ` I~~''L I~,t_ Ho~revec. I hav~ cbaaged n~y domie~e to •
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and am and h~ve beea a bozea fide resideat ot the State ot f'lorida siAre --s'' ~ dap vt ;
19.~~ind I m&k at ~ ~ 1
t l8t»~t aed NweM~l ' ~
~~/~~P G L?" ST . L UC 1 E County. Florida, 3
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and tAis statemeat ia to be takea as m~r dectantioA ot citiunihip. aetu~l kgal residenee and domie~e ia tbe Siate ai Fforida. ~
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IP fOR tHE Pl1RPO5E Of ENRO~LING IF i0R HOMESTEAO PtlRPO ES~
CNl~OREN IN SCHOOI~ PtEASE StATE PIEASE CHECKt ~
' tHElR NAMESI ;
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I FUBTIiE:R CERTIFY that Y wt~l tegister at my local addres~ when the registrati~n booka reopeA. and comply with aU
other requirements of ~ legal resident of this State.
I FU ER CERTI t~at I iu~ve no intention to return to my former domicik. and I iutend to remain iQ
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Fbrida. permanenti; . -
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` ROG R f'01 TS2A , CIERK OF C IRCUI T COU~2T ~ ~
ST. LUC 1 E COUNTY, FLOFt t UA ~
BY:
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EPUTY LERK '
• ~ Bu01t~ PAGE J07 .
Af:il 1',•, 7;
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