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'!'t) TIIE Cl.l:lth (1h'TllE Cl~l(:UIT COUitT, -
ST . L UG 1 E CpUTt'1'Y. I~'[.oltlpA:
This Is my dcclarAlion of 1)omicik and Citi:.cnsAip in the Stat~ of F'lorids tt~at 1 xm CUng this day in a~~co:dsnco. and in
conformity nrilh Sccl'son 2~.'.17. Florida Slatutc~. -
I ws9 formrri a legal rcsidcnt of _ e~~ Aud I
1(~t71 (Statel
residcd al ~ . Ho~vever. I h~ve chenged a~y domicile to
(5tre~t and Nvimb~t) f
upda " And have bcen a bonh fde re"sidcnt otthe State of Florida since ~(o ~ day ot
~ 19~ and I rraide al \
~ (3t:eet ~ad 11umb~sl-=
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ST . LUC I E County. F'lo~~ida,
1(tit71
end this statcment is tu Ms taken a~s my declaratioa ot citiuTMS6ip. aclual legal residence snd domicile in tho Statc of Floridu.
If POR THE PURPOSE OF ENROLLfNG If POR HOMESTEAD PURPOSES~
CHIIUREN IN SCHQOI~.PIEASE STATE PlEASE CHECK2 ~
THEIR NAMESS
. ~ ic~CURDED
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I FURT1iER CERTIFl' lhat I witl register at my local address when t!~e registratian books reopen. and wmply with all
4 other requiremenls ot a 1ega1 resident of this State. -
! 1 FURTHF,~ CFRTIE'Y that I hsve no intcntion to rciurn_to my tormer domicile. and I intend b remxin in
! ~ a ~ . ~ v ~ ~ - - - County.
t(~yl . .
Florida. permancati;. - ~
cOUNTy . .
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~ ~````~.`~.~a~'~°' ~ (Address)
~ SH~orn tu and suhscrihed before ~ne thi~ `j a•r oi `
~ ~
~ . 4.D.19_ 79
ROGER PO i TRAS.: CLERK OF _C tRCUi T C0~~2T
ST. LUC{E COUNTY, FLORIUA ~
BY: - ~
EPUTY LERK ~ p tJV~.? ~
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