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TO TIIE Gl.EItK OF THF: C1RCUIT CAURT. .
ST. LUC 1 E CovNTY. FI.ORIDA: ~
Thi~ u my declaration ot Uucnlcilo ~nd Citlxcuship in tl~e Stata of F'lorida lhal t am liling thia day tn accordnnce, Rii(I fp ?
contorniity with Scrtion 222.17~ Florida Stt~Lutes.
l was lormerlv a Mgal residant ot and 1
. ~ l(~tyl ISlate) f
teaidrd a .Q~.c--~-c_-c .C-~-~-c' . Howover. l hnvo changed mp domlcile to
(3tre~t ~nd Nu+~+?b~rl
and am and have been a bone fide resid~nt ottho Stale otFtorida sincQ _:,~6~'D ~ day ot
_ ~ 19..~. and I reside ~t c~ !~:~..,,~[3.~~~",, ir:c-~"1_-C'c ~l.
' (Streot aad Nua~et)
ST. LUC I E County. Florida, .
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and this sl.atemunt Ls to,be takea as my decluation ot citiaenshlp. sctual legal residence end domicik in lhe.3tate u[ Florida.
IF fOR THE PURPOSE Of EHROLLING IF fOR HOHESTEA~ PURPOSCS~
CHILDREN IN SCHOAL~ PLCASF. Si'ATE PLEAS~ CNECKS
THEIR NAMES; ~
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I FURT}iF.R CEItTIFY that 1 wifl reqicter at my lucal address whea the registration books reopen, and comply with r.lt
otber requi~aments ot a legal residant ot this Slsle. ~
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1 FURT~iER CFRTIFY thst I f~ave no intr.ntion ta rnturn to m former domi~ile. nnd I iniend to remrin in
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E ~ County
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Florida. pcrmancnti~. ' ~ .
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Sw•~rn to and subscriix•J i~efore me tliis day of , ~..L_
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ROGCR P01 TF2AS~ GIERh ~F .G IRGUI T COl.~2T - .
ST. LUCIE COUMTY, FL(~21UA ~
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