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TO 1'IiE CLEttK OF THE CIItCUi1' COURT. . ' , • .
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• ST. LUC i E .
COUNTY. FIARIDA:
Thts i.s my declarstion oi Domicile and Citizen~hip in the SU?te ot Fbrtd~ tf?~t I am C~liag tb~.s dq ia sceordanee, snd tn~
toatormity witA Section 722.1T. Flo~ida StR/ute~. ~ . '
I a~s lormrrl a k resident ot C~ k~~ ' and 1
, ~Z ~ ~,J 1C.ity) lStat~)
resided at y" ~ . However. I bave cAanged my donnicile to •
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and am and hare been a boaa C?d~ resident ot tAe State ot Florid~ since ~ ~ da7 ot
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- 19 ~ l- aad I r~aide tt g-~ f~tJ ~L/t,~ S 0~ W~ ~'t V~
f~ (Stn~t aad Ntim~r)
P fi / l~~~c ~e ST. LUG I E Co~ncr. ~r~., .
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tad this statement is to be takea u my dcelaratia~ oi eiLizenship. actual legal re~idenec and domia~e in tbe State ot Flocid~.
IP FOR THE PURPCSE Of ENROtLING IP F'OR NOMESTEAD PURPOSES~
CHIIOREN iN SCNOOL~ PLEASE S?~TE P~EASE CHECKS ~
' ' TNEIR NANES2
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P aes ~
E~x CtRC'JIT CCL'R
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A~:~ 30 9~ Q AN'T~
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~ I FURTf~ER CERTIFY that I will register at my local addces~ when the registrstion books reopen. and comply with all
otber requircmcnis ot a legal tesident of this State.~
I FU Z CEtiTi hat I have no intention to relurn to my lormer domicile. and I intcad to rem~i~ iu
~ f~ / P~G e , ST . L UC 1 E . County.
• (Cit~) .
Florida. permanenti~.
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Sworn to and suhscril?cd bctorc me this day ot / d 8// J H? f~/V NR S' v/ K? /Q( ~ ~
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ROGER P01 TF2AS, CLERK OF C IRCUI T COU2T ~
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ST. LUG I E COUNTY, f l.Ok 1 UA • ~
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EPUTY Lf.RK
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AGO ~'onn 71 ~
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