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ra T«~ c~.~:liK UF 7t~~: GiHCUIT COUIt•r, - ~
ST . L l1G I C COUNTY~ E I.ORII)A:
9'his is my declnration ot llomlcilo and Citizonship in titr. State of F'loriJa lhat I am GGng this da~ in accordance. ~nJ in
confortnity with S~ciion 2'12.17. Florida Stalulea. .
1 was torm~rl~• d Ie~;AI resident of C/'~ES'I'E~PL~ND, ~ af1 ~ ~ and I
I~ytyl (Statel
resided nt s~ 3 HE~f'~f'/C~ ~7 R• . However. I have changed my domicile to
(5trcet wd TiumDed
nnd am and have t?een a bona Gdo resident ot the State of Florida sinco ~ C" day ot
,
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- end I reside at 198 ~ ~C~W/'U ~ •
(Stieef wd I3umber)
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• LUC/F ST. LUC 1 E County.Fiorida.
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and this ~tatement is to t,e taken as my declnralion ot citizenship. actusl le~al residence and domici~ in lhe State of Flori3n.
I F FOR TlIE PURP4SE Of ENROII. lNG I F FOR HONESTE/~p PURPOSES~
CHPIOREN IN SCHOOL~ PLEASE S7A7E PLEASf CHEC~K2 ~
THE.IR NAMES:
.-,/aH~ ~fl z lA _ ' _
. F!l.tD AND RFCORDED~
/UC/L ~_f~Ar~N~e~ ~~c~~ ~JU":TY. FIA. _
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CL=nri C~?t~'vl' .:~~JRT
I Ft1ItTliEit (:F.RTIFl' that I will rr.~;i~tcr at my l:~cal ~ddress when thc registration h;w'•:s reopen. and cum~ty with ail
' o.her rcquiremcnts ot a Ic~sl msider.t oi this State. .
I .
~ I FURTHE3 Cr.R'flI~'Y thzt I hsve no intenl.ion to return to tny formcr dorr.ici!c-, and I inte~d to remain in
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E . County.
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g Flurida, pcrmanemi;.
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~.tinrn 1•~ ~:n~i r:~Z,:crit~cci bc•(ore me ~his __~~clay ef ~~7' ~~A. 3.3~s~ .
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