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TO TllE CLE1tK OF THE ClRCU1T GOURT~
STt LUG I E COUNTY. 1~'LOKIDA: _
This is my d~xlaration of Aomicile ~nd Ciliunship in tho Stato af Florida th~t I em tiling lhi+ day in accordanco, and in f
contormily with Scction 222.1T~ F'lo:ids Statutce.
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~ wus tormcr~ a lega! resident oi ~ ~ ~ ~ ~ ,R G, , ~11'~~ ~ ~/.s' ~ s d~d 1 ;
eGti~rl l~aee)
nsidc~d at ~.gS[ ~ 2~ ST ~ . However, I have cbanged my domicile to
IStreet and Numper) .
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and am and ha~ e beefl a bona Cde residenl of the State ot Florida since p n,~ o~ day of
-19 9 aad I reside st ~ q-5o ~ 1l ~l O o iP
(8tee~t ~nd Number) .
~-~T-~--7-' ~ v G~~ ~ ST. LUC I E - Coualy. Florida,
((StT) .
and this statemcnt is to bc taken as my dedaralion of citizenship. sctual legal residence nnd domicile in tho State of Florids.
IF fOR THE PURPOS~~ OF ENROIIING IF FOR HOHESTEAD PURPOSES~
CHILDRCN IN SCHOO~.~ P~EASE STATE PLEASC CHECK: ~
tHEiR kAMES2
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, F1LE0 A~t~. ~ECORD~
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~ ~ 1 c ~ T?T~il1 , ~T L.~"'~ r~UNTY.
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I FURTIiER CERTIFY that I wiq register at my local address when the registratioa books reopen. and comply with rill
othcr requirements of a iegal resident ot this State.
I FURTNF:~ CERTIFY that I have no intentiot~ to return to m tormer domicile. and I intend to remain in
~ T. U C 1 E . County.
Icny) .
Fbrida, ~~ermanenti;. ~
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Sworn to and subscribed hclore me lhis ~L...,__ day ot ~1~LG tG.,
~A.D.l9_ / ~
RQGFR PO! Tf2AS~CLERK OF G IRCUI T COt~Z i
ST. L UC I E GOUNTY, F LtN21 UA ~
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