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TO TUF: CI~I:RK OF THE CIItCUIT (AURT. `
ST. I~UC I E COUNTY. I~'I.OItIUA: ~ i'
~ This is m~ declaralion ot nomicile and Citizenship in the Slate ot Florida that I am !'iling lhis day ia acrnrdancc. and in ~
con[ormily K ith Seclion 222.1T. Florida Statutes. ~
1 K•~~ formerl a legal tcsident oi „J ~ ~V ~ ~ ~ ~ ( ` ~ ~ ~ - ~ I
- lCityl (State)
resided at ~ y f H rE $ 7 . liowever, I have changed rmy domieile to
~stnec ane N~me.r? D~ C. I S. ~7 ~ _ aay of
aad am and have becn a bona fido resident of the Stats ot Floride aince
,19 -~nd I reside al so SU K S~~ Q~- v~ •
($treet aod Numbcrl
~Q~~' Q C E _ ST . LUC ! E County. Florida,
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and this statement is to be taken as my declar~tion ot ci:senship. actual legal residence and domicile in the Stalo at Florida.
I~ FQR TNE PURPOSE OF ENRO~LING IF FOR HONESTE/1D PURPOSES~
CHILbREN IN SCNOOI~ PIEASE STATE PIEASE CHECK: f'1,~/ 1
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~ I FURTIlER CERTIFY that I will register at my local addresa when the registralion books reopen, snd cotnply with t~ll
~ other requirements of a kgal resident ot this State.
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€ I FURT}IE~ CERTIFY that I hAVe no intention to mturn to my forn:er domicile. and I intend to remain in
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Florida, permanenti; F 0 IQ T P/~ R C E,
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~ Sworn to and sul~scribc~d brtore mc this _se~ day ot SO I$ Sv~r S E 7 ~ L 1/~ .
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~ . A.D.19_
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ST. LUC I E COUNTY, FLOR t U ~"~~s` .
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