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TO TI1~: CLERK Ol~' Tllt: CIF:CUIT COl1RT~ ~
ST. LUC I E CouN~r~t, F`i.oKlt~n: ~
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This is my derl~r~+tion of Domlcile anJ Citizunship in the State of i'lor+da thal I ara fiiling thts d~+y in sccordnnce. and in +
confor~nity with Section 222.17. Floridt? StAtutes. E
1 was formerl a legal rCSident ot ~~J~ . ~~d I
tCityl I~te1
residc~l at s~~~~y-~~ A~~~ .1lowover. I havo changed my domicile ta
(8lreet and Num /
and t~m and havc bccn a bona tidc residc+nt of tho Stetc of Fiorids since ' day ot
.191L. and I resIde at ~ 0 s d ~ ~ ~
- - ~ (Street asd Number)
S f.~ vC~ /E ST . L l1G I E Couaty. Floride,
1~71
and this statement is tu be taken as my declaration of citue~ship. actual legal residence t?nd domicile in the Statc ot Florids.
IF FOR THE PURPOSE OF ENROLLING . I~' fOR HOMESTEAD PURPOSES~
CHIIOREN IN SCNOOI~ PLEASE STATE PLE11~E CHECK: ~
TNEIR NAHES:
OL
n~i~~v~ ~ C ~ r~ r~~ ~
~ RECORD~t~
~ ~C, cC ~`l!~ OLi~ F~I.E~^Ati~ ~UZiTY~~ A•l
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CLERK CiriC;;IS
I FURTHFR CERTIFl' that I will r~•~ister at my lo:sl address when the registration bouks rec?pen. and eomply with all .
othcr rcquiremcnts ot a Icbal resident of this Staie.
I FURTJIF.:2 CF.RTIFY thaL I t~ave no intentiort to rclurn to mv lormer dn~mi~~~c, and I intcnd Lo remain in
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