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7'O T!!h: CLERK 01~' 9'H~ C1RCUIT COURT.
$T. LUC 1 E covt~t'rY, F'lAItIUA: ~ >
This is my dcclsration of Domicil~ ~nd Citizenship in the State ot t'farida lhal 1 un filiug this dAy ia a~cordanco. and in . •
rnntormi~y vvith Scctiun 222.17. Floride Stututes.
l was torn~rrl a Icgal residcnt ot _ y
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resided ~t l~ ~ S "s~ Howevor. I have changed my dornicile to
- (3tr.+t +u+d Nwnber) '
and am and i~ava been a bona tide traideat ot tho Stale ot Fbrtda stnce ~ day oi ~
,19 7 ~ - and I nside at i ? ~5 ~ E ~//~'~1~/"I r ~"r'~c ~ ~ -
(Stce~t u?d Kumber)
c~' = ST. LUC I E County. Ftorida,
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and this stalemtnt is to be taken aa my deelaration o! citiunship. actuallegal residcnce and'domicile in lhe Statc+ ut l~'loridn. ~
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IF FOR THE PURPOSE OP ENROLLING IP FOR HOMFSTEnQ PURPOSCS~ '
CHII.~REN 1~~ SCHOUL~ P~EASE STl.TE PLC.tiSE CttEGK:
THEIR NAMCS: ' .
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~ FILED ~NO RECORDED'
~ ST. LUC~E.r^UF~TY. FL~. -
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I FURTIiER CERTIFY thal I will register al my local address when the registration books reopen. and coruply with all
other requirements o( a lega{ resident of this State.
I, I FURTi;F.Z CERTTf Y t}iat I hav~ no intention ta return to my tarmer
d~
e~
irile. and I inlcnd to remain in
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~ SK•arn tn and subscril~rd Le~lurc mc /hiv day of /D ~ST ' G~~_ .
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