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TO TH1: CL[:ItK OF' THC: CIItCI.~I'P COUItT. ~
_ ST~_LUC I E _.CnUNTY. ~F'LO[tIUA: ~
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Thi~ is my dcclarrtion ot Domicilu and Cilirc~ship in tho Stnte ot Florida thaL 1 nro filiag this day in accordunco~ and in ~
contarmity with Section '122.17. F lorid~ Sldtules.
~ , ~ ~ 1~ ?1 Ct i r.nd I ' ;
1 was formcr~ a Icgal ~esidc~tl u[ ' ~~u~e~ :
(City1 ~
n sided nl Q 9 ~~~D r~~e . liowcvcr. t he~•o changed my domicife lo f
(Stre~t wd Num~e.) • ~
end nm and hnve brcn a bona tidc rosiJant ot th~ Stnte of Florida sincc ^ r~~~ r / _ day of i
~C~ ~ ~ 1
.14~_~ ~nd I reside at 1/ ~ o ~ P 1ry C C2 Y`
• IStreet ~ad um~)
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k , ST . LUC I E County, Florida. ;
L~ S n ~ ~ ~c~ ~ ~ ~ . ~ -
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and this staten?ent i4 te Im takc:~ ns niy cieclaratiun of citizenship. xctval 1. gal nsidence and domicile in ihe State of 1~'Icri:in.
IF FOR NOHE57EAD PURPOSf::~
If POR THE PURPOSE OF ENROI.IING ` ~
CI~IlOREN IN SCHOOL~ PLE/?SE STATE PLEASE CNECKi ~ ;
7HE IR NAMES: 1~ ~ ~
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~
FiLEO Ah0 RECORbE~~ a ;
. . ~+~t= ~'=UNTY• FLA• ~
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I Ft1R'f1tF.R C.4~:R?iI'1' t'iat I wi!! re~ister at my lxa! sddress whcn the rcgisti ztic~n ba:,ks teo~en, anci comply wi`.h :.1{
~ o'her rec~uirements of a le~;~l resiJent ot this S'ale.
~
~ 1 Fl3RTI1I;~2 CF.RTIF~' that I hlve no intent:on to return to m~ formcr do~
~r~~=~.ilc. :.nd 1 ir.tcnd to remsin_in
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