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43.339Q
TO TH6 CLERK OF TH>~ CIRCUIT COURT. .
ST. LUG 1 E , OOUNTY. FLORIDA:
Tbla V ay? deelantbn of Doaaicik and Citisewbip is tM State of Florida that I am ~ tbie day la aooadanoe, and la
coatorsaity,sritb Section X22.17. Fbrida 8tatutea.
I aas t rme a lepl raideat of ~%~/~a ~ - N T and I
lCf~p) let~tel
f ~
resided at c7 .~1 n~C t.~wiLrL,~ ~ - However. I haw ebae~ed iqy danieile to
tptMe Mi NesMr!
and am and have been a bona tide re~ddent of the State of l:'lorida etace ~ ~
~c~ IS~.~, and I raaide at ~
~ ~ ~
"~~'--fi' ~ ; ~ ° _ ST. LUG 1 E Count, Florida.
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and this statement b ~o be taken as aOr declaration of eltiiensbIp. actual legal ~eae and domicile in the State of Florida.
Ii,iOR THE PURPOSE Oi ENROLt.ING IF FOR HONESTEAO PURPOSES,
' CHILDREN IN SCHOOt., PLEASE STATE PLEASE CHECKS
THE I~R'~'NAMESS ~j
f-Ned- .~~~•b,
FILED AND RECb~~DE'~
y._,_,=,_~r~,~~~n'~w 3T, I:UC!E COUNTY; FL'A:'-
/ _ ::CORD V€R!~~EO
• '79 FE6 .8 . Ali IQ ~ 52
Cl_€RK CtiiCtl!7 COURT
I FURTHER. CERTIFY that I ~l ragister at my local address when the registration books reopen and ~Pb with aU
other requirements of a legal resident of this State.
I~ FURTHER CERTIFY that I have no intention to ntnrn to my former domicile, and I intend to remain in
_ 5T . ~ L' C : ~ ,County.
ic~ri
I Fio~rida~~ern?anend; . ~ +.i
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• ~ ~ ' i _ ( 1 O CO fit. %$0{)1, .
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~vdp before me thL ~ day of 8~fi w~ t c~
• A.D.19_ I ! ~ •
ROGER P01 TRAS,~ CLERK OF CIRCUIT COURT
~ ST. LUGIE COUNTY, FlOR10A
BY:
EPUTY LERK
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