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TO T11E CLERK OF TNE CIRCUIT COURT, ;
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ST. LUC 1 E COUNTY. FLORIDA: ;
• This b my declaration ot Domicilo ~nd Citizenehip in the St~to o[ ~lurida that I~m Cting this day in accordsnco, ~nd tn ;
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eontormity with Section 2~.17. Ftorida Statutea. . ;
~~l n~„~ . _ ~iI and I
I was formerl a legal reside~t ot t~r~ ~
residcd at . However. I have changed my domicile to ~
(SerNt ~nd NumMrl / .
dey ot ~
and am and have been a bona Cde resident o[ the State o[ Ftorida since
1910 ' and I reslde at ~ ' ~
. l3cre.t so ~meerl i
ST . LUG I E County. Ftoriaa. ~
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•nd this statsment is to be tal~ea as my declsration ot citizea~hip. actual legal nsidence and domicile in the Stete of Fiorida. ~
IF FOR THE PURPOSE OF ENROLIING IF iOR HOMESTEAD PURPOSESi
CHIIOREN iN SCNOOL~ PLEASE S7ATE PLEASE CHECK: ~
THEIR A , •
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CIE~K C~RCUIT C UR
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I Fi1RTHF.R CERTIFY that I will register at my locai address when the registration books reopen. and comply with all
i othei~ requimments o[ s Icgal resident oi this State.
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[ I F ;E;t 'PI Y I have ao int~ntion to return to my former domicile. and I intcnd to remain in
$ T. L U C 1 E _ County.
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~ Florida. permancn~i;.
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` ~ day of
- Sworn to and suhsc~it~ed bcforo mc this '
fis
. A.D.191
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- ROGf_R OI~F2AS~ CLERK OF~G IRCUI T COtJ~~T
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~ ST. LUC I E COU~ITY, FI.OR 1 UA •
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