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TO Tli~ CI.A:FtK OI' THE CIRCUIT COUIiT.
ST~ LUC I E COUNTY~ F1.ORIUA: ~
-:~,T~j~ 4s my ~eclaration oi Domicite nnd Citizcn~hip io the Siate of F lorid~ thnl l am filing this day in sccordaneo, and in
cp~(pctnily witA Scetian 222.1?. F lorid~ Sti+tutoa.
' 1 w~.+ farni~rl • a le6al resident ot ~ and I
- IGti~YI lState)
msidcd At 7' 3 ?v ~~V e~ J~ R'e e"~ - Ilowever, I hnvo chaoged my domicile to
(Stnet ~nd Numbar)
and am ~nd havc~ bc~A a bona fi~c resident oI tho Strto oi Florida aince ~ day ot
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J A- ~v ~a ,19 u~d I reside~at ~ 0 l'~ / ~D~ ~ S~.
_ (3fse~t aad Number)
~ f- ~i e/'G ~ _ ST. LllG I E councy. Florida.
IGYt~1
and this statement is to be taken xs my declsralion of citizcnship, aMual legal nsidonce and domicile in the St~te ot Fforida.
I:F FOR THE PURPOSE OF ENROILING IF POR HONES7EA~ PUP.POSES~
~'~~CNILDREN IN SCHOO~~ PLEASE STATE PLEASE CHECK: ~
THE IR I~AHES: ~
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~ ~~MM~I lCti~- _NIEPII~ ,r~_E~' ..r~~; ~~ECOR7ED
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~ Q ~-ANN ; 01 '~Z . . , ~
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4.31625 ~
. ~ - ' '79 ~ 2 ~ 9 : 38
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I FiIRTIiER CERTIFY Lhat I will registcr at my )ocal address when the registration books reopen, and oomply with all
other requirements of a legal resident oE this State.
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I FURTHF.:t CF.RTIFY that I have no intcntiun to return to my lormer domicile. and I intend to remain in
~ ~ . U C i E County.
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~ lCit~) _
` Florida. permanentl;.
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' SH•orn to ~+nd suLsccibt•d before me this a~y ot T• l"C ~ 7" A
. A.U.19..
~ ROGER P01 TR~S, _ERK OF C I F~CU I T COt~2T
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~ ST. LUGIE COUNTY, F ~ tUA ~
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