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7'0 TiIE CLF:1tK OF' 1'll E CiItCU1T COURT,
ST, I.UC t E Cout~'~'x. FI.O1tIDA:
This is my drelaration of I~omicilo and Citi~anship ia the St,nte ot Florida thnt 1 un rling t6is dar ta aecordanee, arnl in
contormity with Sertion 222.1?. Flurida Stututas. . -
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I was fortn~r3v a legal reaident ot ~d~- ~nd I
lCitrl l&uel
rcsided xt 5 ''r• . liowever. I ha~ e changed my domicile lo `
ttest Rnd j~lumber) '
and am and have becn a bona fidc rasidcnt of the State ot Florida si~ce ~ s~ day oi a
N~' 19~~ tad I reside at y S 5. ,
(Street ?ud t:umber)
ST . L UG I E CouAty , t~~IOrtt~A, i
Ic;~r) ' t
and this s tem~:nt is to be take~ ac my dcrlaration of ~iliunship. Actual !egal nsidence and domieile in the Stste of Fioridn.
i F FOR. 7HE PURPOSE OF ENROLL ING I F i'OR HOHEStEAD PL•RPOSE-S~ ~
CH 1 LORi.N 1 N SCHOOL= PLEASE STAY€ PLCASE CHECY.: #
THE IR tJAMES: ~
f"t~EO AND u
TYOF A•
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I FIJRTHER CER'!`1FY that Y wil~ regi.ster at my local address when lbe registration books nwpen, and comply with nll
other requiremenfs oi a legal residc~t of lhis Stntc.
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I FURTIlE:2 CF;RTIFY thr.t I ha~e no iniention to return to mv former c;omieile, aad I intend to remain in ;
' U C ! ~ . C~iunty,
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Plorida, pcrmanenti,~.
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~f r '~y~~a rE ~~°S~:oen~ . A ? Ti¢ ~~A'Q.,
Gc~f COUN~•~~ ~ . ~
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orn to aaJ Suhvcribed t?e(ore me this ,_.L.._„ duy ot
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RoGf_R_ POi TRns
~R~ERK OF G lRCU! T COIJ~tT
ST. LUC I E COUNTY, Ft_OR t UA ~ ,
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